title: Management of anticoagulation and hemostasis for pediatric extracorporeal membrane oxygenation.
abstract: Compared to in situ vascular physiology where pro and anti-hemostatic processes are in balance to maintain hemostasis, the use of ECMO in a critically ill child increases the risk of hemorrhagic or thromboembolic events due to a perturbation in the balance inherent of this complex system. The ECMO circuit has pro-hemostatic effects due to contact activation of hemostasis and inflammatory pathways. In addition, the critical illness of the child can cause dysregulation of hemostasis that may shift between hyper and hypocoagulable states over time.
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Washington School of Medicine in St Louis, 8th floor, Northwest Towers, One Children's Place, St Louis, MO 63110, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Saini
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Washington School of Medicine in St Louis, 8th floor, Northwest Towers, One Children's Place, St Louis, MO 63110, USA. Electronic address: spinella_p@kids.wustl.edu.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
mesh_terms: D000284:Administration, Oral; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D002648:Child; D016903:Drug Monitoring / Q000379:methods*; D019317:Evidence-Based Medicine; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D006487:Hemostasis / Q000187:drug effects; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D010372:Pediatrics / Q000379:methods*; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy
chemical_list: D000925:Anticoagulants; D006490:Hemostatics
keywords: Anticoagulation; Congenital heart defect; Extracorporeal membrane oxygenation; Heparin; Platelet function; Thromboelastography