Page 34 - ANZCP Gazette MAY 2014

The following pages contain the abstracts from the ANZCP 30th Annual scientific Meeting, Melbourne.
ANTICOAGULATION STRATEGIES AND DIFFICULTIES IN PAEDIATRIC EXTRACORPOREAL LIFE SUPPORT
Background
Paediatric extracorporeal life support (ECLS) providers around the world are increasingly concerned that current recommendations for anticoagulation management are of limited value in understanding their patient’s level of anticoagulation and protecting them from complications.
Objective
To audit international experience with bleeding and clotting complications on paediatric ECLS, evaluate traditional concepts of haemostasis and contemporary practice of anticoagulation management, and discuss modern concepts and potential future strategies.
Methods
Extracorporeal Life Support Organisation (ELSO) database search, and literature review.
Findings
Bleeding and clotting complications rates in paediatric ECLS are increasing internationally. It would appear that traditional concepts of haemostasis and recommended anticoagulation practice do not translate into satisfactory patient outcomes in the current ECLS era. The problems identified are sicker ECLS patients, a bad nonagenarian anticoagulant, abundance of device technologies, maturation issues of the haemostatic system in infants, and inadequate anticoagulation monitoring tools.
Conclusion
Anticoagulation strategies for ECLS need to be designed around modern concepts of haemostasis, resulting in development of anticoagulants that are trialled by validating laboratory measures of drug concentrations and effect in terms of clinical safety and efficacy. Furthermore, drug-specific point-of-care (POC) anticoagulation monitoring tests along with POC global haemostatic function tests are required. And finally, ECLS providers should expect ready-made and validated, technological fully integrated and streamlined systems incorporating pumps, circuits, anticoagulant, and POC monitoring tools. The Steve- Jobs-philosophy for ECLS !
Christian Stocker MD FCICM Paediatric Intensive Care Unit, Mater Children’s Hospital Raymond Tce, South Brisbane Qld 4101, Australia
32 MAY 2014 | www.anzcp.org