ECMO Anticoagulation with Dr. Ali McMichael and Dr. Lisa Settle--Part 2

6 snips

Oct 17, 2022

Dr. Ali McMichael and Dr. Lisa Settle discuss the challenges of interpreting lab test results in neonates on ECMO, the use of thromboelastography tags to assess anticoagulation, and managing anticoagulation in patients with elevated bilirubin and triglyceride levels. The podcast also explores patient selection for ECMO and alternative interventions for hemorrhaging.

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Introduction

00:00 • 2min

Goal range for APTT and types of tests for ECMO anticoagulation

02:03 • 3min

The Use of Tags in Assessing Anticoagulation and Clot Formation

05:19 • 3min

Interpreting Lab Test Results in a Neonate on VA ECMO

08:17 • 3min

Managing Anticoagulation on ECMO

11:30 • 13min

Dr. Ali McMichael who was previously with us here in Dallas is now an Associate Professor of Pediatrics at the University of Arizona and a pediatric intensivist at Phoenix Children’s Hospital. Her interests include medical education and ECMO anticoagulation. She is the first author of the 2021 ELSO Adult and Pediatric anticoagulation guidelines.

Dr. Lisa Settle is a pediatric critical care fellow at UT Southwestern and Children’s Medical Center in Dallas. Her research interests include anticoagulation management in ECMO, specifically focusing on the utilization of TEG data in the neonatal ECMO population.

After listening to this series, learners should be able to:

Briefly describe neonatal and pediatric developmental hemostasis.
Recognize the key differences in anticoagulation of neonates, children and adults.
Describe the advantages and disadvantages of commonly used anticoagulants: unfractionated heparin, bivalirudin and argatroban.
Describe common laboratory testing for anticoagulation on ECMO and their limitations: ACT, aPTT, anti Xa, VHAs
Troubleshoot discrepant anticoagulation laboratory testing.
Discuss future research in ECMO and anticoagulation

References:

Levy JH, Staudinger T, Steiner ME. How to manage anticoagulation during extracorporeal membrane oxygenation. Intensive Care Med. 2022 Jun 11:1–4. doi: 10.1007/s00134-022-06723-z. Epub ahead of print. PMID: 35689697; PMCID: PMC9187844.

McMichael ABV, Ryerson LM, Ratano D, Fan E, Faraoni D, Annich GM. 2021 ELSO Adult and Pediatric Anticoagulation Guidelines. ASAIO J. 2022 Mar 1;68(3):303-310. doi: 10.1097/MAT.0000000000001652. PMID: 35080509.

Ryerson LM, McMichael ABV. Bivalirudin in pediatric extracorporeal membrane oxygenation. Curr Opin Pediatr. 2022 Jun 1;34(3):255-260. doi: 10.1097/MOP.0000000000001131. PMID: 35634698.

Saini A, Spinella PC. Management of anticoagulation and hemostasis for pediatric extracorporeal membrane oxygenation. Clin Lab Med. 2014 Sep;34(3):655-73. doi: 10.1016/j.cll.2014.06.014. Epub 2014 Jul 24. PMID: 25168949.

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.