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Description

Background: Due to supply chain challenges, our institution transitioned from Pediatric Quadrox oxygenators to Nautilus oxygenators for neonatal and pediatric extracorporeal membrane oxygenation (ECMO) patients. During this transition, variations in anticoagulation results were observed with bivalirudin, the first-line anticoagulant, in patients weighing less than 8 kg. This study aimed to evaluate heparin as an alternative anticoagulant in this patient population utilizing Nautilus oxygenators. Methods: A retrospective analysis was conducted on 29 neonatal and pediatric ECMO patients (weight range: 2.3–6.1 kg). Patients were divided into three groups based on oxygenator and anticoagulant type: · Group 1: Quadrox with bivalirudin (n=11) · Group 2: Nautilus with bivalirudin (n=7) · Group 3: Nautilus with heparin (n=11) Metrics analyzed included heparin-neutralized partial thromboplastin time (hPTT), prothrombin time (PT), and circuit manipulations. Data normality was assessed using the Shapiro-Wilk test, and comparisons were performed using the Kruskal-Wallis test with post-hoc Dunn’s pairwise analysis. Results: Significant differences in hPTT (χ² = 12.695, p = 0.0018) and PT (χ² = 9.353, p = 0.009) were observed among oxygenator-anticoagulant groups. Post-hoc analysis revealed significant differences between: · Group 1 vs. Group 2 (hPTT, p = 0.0154; PT, p = 0.018) · Group 2 vs. Group 3 (hPTT, p = 0.0017; PT, p = 0.018) No significant difference was found between Group 1 and Group 3 (p = 1.000), suggesting comparable performance between Quadrox-bivalirudin and Nautilus-heparin. Circuit manipulation frequency did not significantly differ between groups (χ² = 2.03, p = 0.362), indicating procedural consistency across oxygenator-anticoagulant combinations. Conclusion: The transition to Nautilus oxygenators necessitated a reassessment of anticoagulation strategies. Findings suggest that heparin may be a viable alternative to bivalirudin for patients less than 8 kg using Nautilus oxygenators, providing a potential strategy to optimize anticoagulation management in ECMO patients. Further prospective studies are warranted to validate these findings.

Publication Date

3-2025

Disciplines

Critical Care | Pediatrics

When and Where Presented

Presented at the 41st Annual ECMO and the Advanced Therapies for Respiratory Failure Symposium; Keystone, Colorado; March 2-5, 2025.

Comparative Analysis of Oxygenators and Anticoagulation Strategies in Neonatal and Pediatric ECMO Patients

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