Coagulation parameter thresholds associated with non-bleeding in the eighth hour of adult cardiac surgical post-cardiotomy extracorporeal membrane oxygenation

Jeffrey B. Riley, Gregory J. Schears, Gregory A. Nuttall, William C. Oliver, Mark H. Ereth, Joseph A. Dearani

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Excessive bleeding and allogeneic transfusion during adult post-cardiotomy venoarterial extracorporeal membrane oxygenation (ECMO) are potentially harmful and expensive. Balancing the inhibition of clotting and distinguishing surgical from non-surgical bleeding in post-operative period is difficult. The sensitivity of coagulation tests including Thromboelastography ® (TEG) to predict chest tube drainage in the early hours of ECMO was examined with the use of receiver-operating characteristics (ROC). The results are useful to incorporate in clinical evidence-based algorithms to guide management decisions. In the eighth hour of ECMO, 26 of the 53 adult patients (49%) studied were identified as non-bleeders (less than 2.0 mL/kg/h). All had experienced various types of cardiac surgical procedures. Fifty-two percent were female and the group was 54 ± 19 (mean ± 1 SD) years old. The coagulation parameter threshold with the maximum sensitivity and specificity to predict non-bleeding at 8 hours on ECMO was the kaolin plus heparinase TEG maximum amplitude (KH-TEG MA) at a significant ROC threshold (t) > 50 mm. The activated partial thromboplastin time (aPTT) t < 49 seconds, KH-TEG alphaangle t > 51°, and the kaolin activated clotting time (ACT) t < 148 seconds were sensitive predictors of non-bleeders. The whole-blood KH-TEG MA was superior to the plasma-based aPTT or International Normalization Ratio (INR) to predict bleeding in the eighth hour of ECMO. Using coagulation laboratory thresholds that predict non-bleeding can begin a process of identifying patients earlier that are likely to bleed. Awareness of these parameter thresholds may improve care through patient protection from unnecessary transfusion and prolonging the life of the ECMO circuit. An algorithm incorporating the ROC thresholds was created to help recognize surgical bleeding to minimize unnecessary transfusions.

Original languageEnglish (US)
Pages (from-to)71-78
Number of pages8
JournalJournal of Extra-Corporeal Technology
Volume48
Issue number2
StatePublished - 2016

Keywords

  • Anticoagulation
  • Blood component transfusion
  • Coagulation
  • Extracorporeal life support
  • Extracorporeal membrane oxygenation
  • Hemorrhage
  • Receiver operating characteristics
  • Thromboelastography

ASJC Scopus subject areas

  • Medicine(all)

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