A. Elias, C. Casado, Ana Mayordomo, R. García, Diego Solis, Blanca Ramirez
{"title":"新生儿和儿童ECMO中的抗凝管理","authors":"A. Elias, C. Casado, Ana Mayordomo, R. García, Diego Solis, Blanca Ramirez","doi":"10.36579/rep.2019.67.3","DOIUrl":null,"url":null,"abstract":"Introduction: Despite significant advances in the materials, components and techniques used for extracorporeal life support in recent years, the management of anticoagulation in ECMO remains controversial, the objective of this protocol is to develop an update for anticoagulation and its control for infants ECMO.\nDevelopment: Unfractionated heparin is the drug of choice for anticoagulation in ECMO. The heparin dose used in pediatrics have been mostly adapted from the experience in adults without a corresponding validation, as well as limiting the absence of randomized clinical trials in children. After the assessment of the patient and a possible correction of coagulopathies, prior to establishment of ECMO, as well as decide the administration of a heparin bolus of 50-100 IU/kg of body weight at the time prior to cannulation. At 5-10’ of beginning ECMO a ACT control is made, if the value is greater than 300 sg, ACT is repeated at 30-60’. Once the ACT is less than 300, an infusion starts between 10-20 IU/kg/h, in the absence of major bleeding. Controls will be carried out every 30’ to stabilize the ACT in the chosen range. For the control, the ACT will be used, mainly, and the APTT, with better results the higher the child's age, although the anti-Xa test is the only laboratory test that shows a strong correlation with the heparin dose administered in ECMO.","PeriodicalId":302682,"journal":{"name":"Revista Española de Perfusión","volume":"46 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anticoagulation management in neonatal and pediatric ECMO\",\"authors\":\"A. Elias, C. Casado, Ana Mayordomo, R. García, Diego Solis, Blanca Ramirez\",\"doi\":\"10.36579/rep.2019.67.3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction: Despite significant advances in the materials, components and techniques used for extracorporeal life support in recent years, the management of anticoagulation in ECMO remains controversial, the objective of this protocol is to develop an update for anticoagulation and its control for infants ECMO.\\nDevelopment: Unfractionated heparin is the drug of choice for anticoagulation in ECMO. The heparin dose used in pediatrics have been mostly adapted from the experience in adults without a corresponding validation, as well as limiting the absence of randomized clinical trials in children. After the assessment of the patient and a possible correction of coagulopathies, prior to establishment of ECMO, as well as decide the administration of a heparin bolus of 50-100 IU/kg of body weight at the time prior to cannulation. At 5-10’ of beginning ECMO a ACT control is made, if the value is greater than 300 sg, ACT is repeated at 30-60’. Once the ACT is less than 300, an infusion starts between 10-20 IU/kg/h, in the absence of major bleeding. Controls will be carried out every 30’ to stabilize the ACT in the chosen range. For the control, the ACT will be used, mainly, and the APTT, with better results the higher the child's age, although the anti-Xa test is the only laboratory test that shows a strong correlation with the heparin dose administered in ECMO.\",\"PeriodicalId\":302682,\"journal\":{\"name\":\"Revista Española de Perfusión\",\"volume\":\"46 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2019-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Revista Española de Perfusión\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.36579/rep.2019.67.3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista Española de Perfusión","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.36579/rep.2019.67.3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Anticoagulation management in neonatal and pediatric ECMO
Introduction: Despite significant advances in the materials, components and techniques used for extracorporeal life support in recent years, the management of anticoagulation in ECMO remains controversial, the objective of this protocol is to develop an update for anticoagulation and its control for infants ECMO.
Development: Unfractionated heparin is the drug of choice for anticoagulation in ECMO. The heparin dose used in pediatrics have been mostly adapted from the experience in adults without a corresponding validation, as well as limiting the absence of randomized clinical trials in children. After the assessment of the patient and a possible correction of coagulopathies, prior to establishment of ECMO, as well as decide the administration of a heparin bolus of 50-100 IU/kg of body weight at the time prior to cannulation. At 5-10’ of beginning ECMO a ACT control is made, if the value is greater than 300 sg, ACT is repeated at 30-60’. Once the ACT is less than 300, an infusion starts between 10-20 IU/kg/h, in the absence of major bleeding. Controls will be carried out every 30’ to stabilize the ACT in the chosen range. For the control, the ACT will be used, mainly, and the APTT, with better results the higher the child's age, although the anti-Xa test is the only laboratory test that shows a strong correlation with the heparin dose administered in ECMO.