WIP 03 - Efficacy of tiered heparin boluses for anticoagulation in neonates on ECMO

Publication Number: WIP 03.7607

Trisha Mulamreddy, University of California Davis Children's Hospital, Sacramento, CA, United States; Katherine Phelps, University of California Davis Children's Hospital, Sacramento, CA, United States; Laura E.. Kenny, UC Davis Children's Hospital, Sacramento, CA, United States; Stephanie Mateev, UC Davis, Sacramento, CA, United States

Background: Extracorporeal Membrane Oxygenation (ECMO) is an instrumental means of support for critically ill infants. Anticoagulation is necessary for neonates on ECMO as thrombotic events can lead to frequent circuit changes, elevate the risk of bleeding, and contribute to overall mortality. Due to complexity and variability of neonatal coagulation system, there is limited evidence to establish best practice guidelines. This study hopes to provide more evidence towards using tiered heparin boluses to reduce complications and improve morbidity and mortality for neonates on ECMO.

Objective: This study seeks to identify if tiered heparin boluses for neonates on ECMO can lead to a reduction in time to therapeutic goal thereby reducing complications such as incidence of thrombus and number of circuit changes required.

Design/Methods: This single-center, qualitative, retrospective chart review from 2020 to 2023 will be done comparing: modes of ECMO; gestational age; laboratory data (e.g. coagulation profiles, platelet, anti-Xa levels, and other data); starting and subsequent dosing of heparin; number and type of transfusions; number and type of thrombi; number of circuit changes including timing and reasons; time to therapeutic heparin goal; hours on ECMO; and complications from anticoagulation.

IRB exemption received. Data collected from EMR and analyzed will include descriptive approach to summarize patient demographics and clinical characteristics. Descriptive statistics such as counts and percentages will be used to summarize categorical data (types of thrombi, circuit change reasons, transfusion type). Chi-squared or Fisher’s exact tests will be used to compare p-values between these variables. For continuous variables such as anti-Xa levels, heparin dose, and hours of ECMO, means and standard deviations will be calculated. Mann-Whitney or Kruskal Wallis tests will be used to compare p-values between groups. Data analysis will be done prior to April 1st, 2025.