ECMO Anticoagulation and Thrombosis by C. VanderPluym | OPENPediatrics

Sep 22, 2022

Dr. Christina VanderPluym, Co-Director of the Stroke and Cerebral Vascular Center at Boston Children’s Hospital, shares her expertise on anticoagulation management in pediatric patients using extracorporeal support devices. She discusses the complexities of managing heparin therapy, compares it with bivalirudin, and emphasizes the need for tailored approaches to minimize complications. Dr. VanderPluym also highlights the importance of monitoring hemostasis in children with ARDS and the challenges posed by evolving guidelines. It's a vital listen for anyone in pediatric care!

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Intro

00:00 • 3min

Hemostasis in Pediatric ARDS Management

03:29 • 8min

Navigating Anticoagulation Challenges in Pediatric Mechanical Support

11:05 • 6min

Shifting Potencies: Reevaluating Heparin Dosage in Pediatric Care

16:51 • 2min

Bivalirudin in Pediatric Ventricular Support

19:06 • 9min

In this World Shared Practice Forum podcast, Dr. Christina VanderPluym, Co-Director of the Stroke and Cerebral Vascular Center and Medical Director of the Cardiac Anti-thrombosis Management and Monitoring Program at Boston Children’s Hospital, discusses emerging concepts in managing anticoagulation of extracorporeal support devices, with a focus on reducing complications such as hemorrhage and thrombosis. She shares her views on the therapeutic offerings currently available for anticoagulation in pediatric mechanical circulatory support, as well as insights into her own clinical practice, along with data from the pediatric ventricular assist device population. Upon listening to this presentation, learners should be able to: - Describe the current state of anticoagulation therapy and monitoring in pediatric extracorporeal support - Compare the advantages and limitations of heparin and bivalirudin for pediatric anticoagulation - Identify areas of future promise in the field of pediatric anticoagulation for extracorporeal devices Articles referenced: • Ghbeis, M. B., Vander Pluym, C. J., & Thiagarajan, R. R. (2021). Hemostatic Challenges in Pediatric Critical Care Medicine-Hemostatic Balance in VAD. Frontiers in pediatrics, 9, 625632. https://doi.org/10.3389/fped.2021.625632 • VanderPluym CJ, Cantor RS, Machado D, et al. Utilization and Outcomes of Children Treated with Direct Thrombin Inhibitors on Paracorporeal Ventricular Assist Device Support. ASAIO J. 2020;66(8):939-945. doi:10.1097/MAT.0000000000001093 (13:45) • https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-update-follow-public-health-alert-about-changes-heparin-sodium-usp (18:05) • Thompson K, Alred J, Deyo A, Sievert AN, Sistino JJ. Effect of New Heparin Potency on Activated Clotting Time during Pediatric Cardiac Surgery: A Retrospective Chart Review. J Extra Corpor Technol. 2014;46(3):224-228. (18:20) Additional resources: • www.actionlearningnetwork.org (26:49) Publication date: September 22, 2022. Citation: VanderPluym C, Daniel D, Burns JP. ECMO Anticoagulation and Thrombosis. 9/2022. Online Podcast. OPENPediatrics. https://youtu.be/y4f8NiDJp0g. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu