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Hemorrhagic and thrombotic complications on Extracorporeal Membrane Oxygenation (ECMO) support are associated with significant morbidity and mortality. There is a paucity of literature describing the incidence and management of Gastrointestinal (GI) bleeding on ECMO. We describe the use of enteral tranexamic acid (TXA) as an alternative strategy in two pediatric patients with GI hemorrhage on ECMO. Case 1 A 5-year-old with Wilms Tumor required Veno-Venous ECMO due to respiratory failure associated with pulmonary hemorrhage and air-leak syndrome. Her course was complicated by severe GI hemorrhage refractory to IV proton pump inhibitor (PPI), IV TXA and octreotide infusions. Concomitant IV TXA and cessation of systemic anticoagulation coincided with emergent transition to Veno-Arterial (VA) ECMO after cannula thrombosis. Procedural interventions included esophagogastroduodenoscopies (EGD) revealing gastric ulcers, two endovascular embolization procedures, and a third arteriogram due to continued bleeding that did not identify a source. Enteral TXA (20 mg/kg q 8 hours) was then begun with resolution of GI bleeding, reduction in blood product transfusion and no further emergency circuit changes. She survived to hospital discharge. Case 2 A 3-year-old with a burn injury required VA ECMO due to cardiopulmonary collapse. Her course was complicated by GI hemorrhage. She received a PPI, octreotide infusion and was started on IV and enteral TXA (10 mg/kg q 8 hours). An EGD did not identify a bleeding source. There was no interruption in circuit anticoagulation or integrity. She remained on enteral TXA for 48 hours until GI bleeding resolved. She survived to ECMO decannulation. Patients supported by ECMO require systemic anticoagulation thus making GI bleeding difficult to manage. We report the use of enteral TXA to provide anti-fibrinolysis. This was associated with cessation of bleeding but not associated with further circuit thrombosis. Enteral TXA can be an additional tool used for GI bleeding on ECMO.


Critical Care | Pediatrics


Presented at the EuroELSO Virtual Congress; May 5-7, 2021.

Utilization of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage in Pediatric Patients on ECMO