Coagulation factor activity during neonatal extra-corporeal membrane oxygenation

Byline: Philip Arnold (1), Sue Jackson (2), Jonathan Wallis (3), Jon Smith (4), David Bolton (5), Simon Haynes (6) Keywords: Extra-corporeal membrane oxygenation Coagulation Bleeding Blood transfusion Abstract: Objective: To ascertain the activity of major coagulation factors during the first 24 h of extra-corporeal membrane oxygenation (ECMO) used to support hypoxaemic neonates. Design and setting: A prospective observational study in a regional centre for ECMO and paediatric cardiac surgery, placing 15--20 neonates on ECMO per year. Patients: Ten neonates receiving ECMO for severe hypoxaemia. Measurement and results: The activity of major clotting factors, of the inhibitor anti-thrombin III and of markers of blood activation were measured during the first 24 h of neonatal extra-corporeal membrane oxygenation (ECMO) and prior to initiation of ECMO. There was laboratory evidence of factor deficiency and of activation of coagulation at all stages. The initiation of ECMO leads to an initial worsening of coagulopathy, but factor deficiency and abnormal activation of coagulation is also seen prior to ECMO in these very sick neonates. Conclusion: If factor deficiency is to be avoided a pro-active approach is required to rapidly correct factor activity. This would include the use of fresh frozen plasma. The effect of such an approach on outcome is at yet uncertain. Author Affiliation: (1) Department of Anaesthesia, Alder Hey (Royal Liverpool Children's Hospital), Eaton Road, Liverpool L12 2AP, UK (2) Department of Anaesthesia, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne, UK (3) Department of Haematology, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne, UK (4) Department of Cardiothoracic Anaesthesia and Intensive Care, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne, UK (5) Department of Cardiothoracic Anaesthesia and Intensive Care, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne, UK (6) Department of Cardiothoracic Anaesthesia and Intensive Care, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne, UK Article History: Received Date: 21/12/2000 Accepted Date: 30/04/2001 Article note: Final revision received: 6 April 2001 Electronic Publication