Reduced Intracranial Hemorrhage with Anticoagulation Guideline Implementation

Hemorrhagic and thrombotic complications, including intracranial hemorrhage, embolic stroke, surgical bleeding, and circuit thrombosis, are common during extracorporeal membrane oxygenation (ECMO), occurring in up to 50% of patients. These complications have a significant impact on morbidity and mortality. Our objective was to implement standardized ECMO anticoagulation guidelines for the pediatric cardiothoracic intensive care unit (CTICU) to reduce the incidence of intracranial hemorrhage while on ECMO. All CTICU patients who received ECMO from January 2016 to December 2020 were retrospectively reviewed. Standardized ECMO anticoagulation guidelines were implemented in the fourth quarter of 2017. Variables and clinical outcomes before and after guideline implementation were compared. From January 2016 to December 2017, there were 22 separate ECMO runs. Eight of 22 (36%) suffered intracranial hemorrhage while on ECMO. Seven of 8 (88%) were withdrawn from ECMO secondary to bleed and expired prior to hospital discharge. From January 2018 to December 2020, there were 22 separate ECMO runs in the CTICU. Three of 22 (14%) suffered intracranial hemorrhage while on ECMO. One of 3 (33%) expired prior to hospital discharge. Implementation of standardized ECMO anticoagulation guidelines in the CTICU was successful in improving clinical outcomes as evidenced by reduction in the incidence of intracranial hemorrhage in this high-risk patient population.