Correlation of anticoagulation assays with bleeding during extracorporeal membrane oxygenation at a tertiary pediatric hospital

IntroductionDue to anticoagulation during Extracorporeal Membrane Oxygenation (ECMO), patients face a higher risk of bleeding. This study aimed to assess the correlation between anticoagulation assays and hemorrhage in ECMO patients.MethodsWe reviewed records from patients in our critical care units, comparing anticoagulation parameters with clinical outcomes. Statistical analyses included the Wilcoxon rank sum test for continuous variables and chi-square or Fisher's exact tests for categorical variables. We used Kaplan-Meier curves to depict hemorrhage incidence and logistic regression to identify factors associated with bleeding and mortality. Linear regression assessed coagulation factors linked to length of stay (LOS).ResultsOf 76 patients, 32 (42.1%) experienced hemorrhage; 15 (46.9%) of these survived. Survivors had a higher proportion without bleeding (68.2%). Hemorrhage patients had more circuit changes (18.8% vs 2.3%, p = .01). The 10-, 20-, and 30-days cumulative hemorrhage incidences were 36.9%, 58.8%, and 72.5%, respectively. Multivariable analysis suggested that bleeding patients had a higher aPTT prior to the bleeding event compared with the median aPTT in non-bleeding patients (p = 0.04), and ACT and PT levels showed a trend towards a significant association (p = 0.06). Longer ECMO runs and circuit changes increased hemorrhage risk (OR = 1.004 and OR = 12.85, respectively).ConclusionOur study found that higher aPTT and longer ECMO duration are independent hemorrhage risk factors, underscoring the need for timely ECMO decannulation.