Thromboelastography in Children Undergoing Extracorporeal Membrane Oxygenation

Background Children undergoing extracorporeal membrane oxygenation (ECMO) are at risk of hematologic and coagulation complications, including intracranial hemorrhage. Thromboelastography is used to monitor anticoagulation in patients receiving ECMO, but no data for its use in children are available. Objective To evaluate the incidence of complications when managing anticoagulation with thromboelastography or with conventional coagulation tests (activated clotting time, plasma fibrinogen level, and platelet count) among children receiving venoarterial or venovenous ECMO. Methods This single-center, prospective, retrospective, observational study included patients less than 18 years old who required ECMO. Outcomes were compared between a conventional test group and a thromboelastography group. The primary outcome was critical hemorrhage or pump failure leading to treatment termination. Results Each group included 17 patients. Twenty-one patients (17 in the conventional test group, 4 in the thromboelastography group) were enrolled retrospectively. Thirteen patients (all in the thromboelastography group) were enrolled prospectively beginning December 26, 2022. Patient age did not differ between groups (median [IQR] age, 2 [0-6] months). Significantly fewer critical complications occurred in the thromboelastography group (11%) than in the conventional test group (59%) (odds ratio, 10.71; 95% CI, 1.84-62.5; P = .01). The 30-day survival rate after ECMO was higher in the thromboelastography group than in the conventional test group, but the difference was not significant (P = .08). Conclusions Managing anticoagulation with thromboelastography, as compared with conventional tests, decreased the frequency of critical complications among children undergoing ECMO.