ECMO Anticoagulation with Dr. Ali McMichael and Dr. Lisa Settle--Part 1

Oct 3, 2022

Dr. Ali McMichael and Dr. Lisa Settle discuss challenges in anticoagulation on ECMO, differences between adults and children, heparin resistance in neonates, and the use of bivalirudin as an alternative anticoagulant. They highlight the need for further research in ECMO anticoagulation.

Ask episode

Chapters

Transcript

Episode notes

Introduction

00:00 • 3min

Anticoagulation in Pediatric Patients on ECMO

02:48 • 5min

Heparin Resistance in Neonates: Definitions and Treatments

08:17 • 5min

ECMO Anticoagulation: Starting and Transitioning with Different Agents

13:14 • 2min

Differences Between Bivalarudin and Heparin as Anticoagulants in ECMO Patients

14:59 • 6min

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

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

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.