Viscoelastic Testing in Pediatric Mechanical Circulatory Support

Pediatric mechanical circulatory support can be lifesaving. However, managing anticoagulation is one of the most challenging aspects of care in patients requiring mechanical circulatory support. Effective anticoagulation is even more difficult in pediatric patients due to the smaller size of their b...

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Autores principales: Regling, Katherine, Saini, Arun, Cashen, Katherine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120594/
https://www.ncbi.nlm.nih.gov/pubmed/35602480
http://dx.doi.org/10.3389/fmed.2022.854258
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author Regling, Katherine
Saini, Arun
Cashen, Katherine
author_facet Regling, Katherine
Saini, Arun
Cashen, Katherine
author_sort Regling, Katherine
collection PubMed
description Pediatric mechanical circulatory support can be lifesaving. However, managing anticoagulation is one of the most challenging aspects of care in patients requiring mechanical circulatory support. Effective anticoagulation is even more difficult in pediatric patients due to the smaller size of their blood vessels, increased turbulent flow, and developmental hemostasis. Recently, viscoelastic testing (VET) has been used as a qualitative measure of anticoagulation efficacy in patients receiving extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD). Thromboelastography (TEG®) and thromboelastometry (ROTEM®) provide a global qualitative assessment of hemostatic function from initiation of clot formation with the platelet-fibrin interaction, platelet aggregation, clot strength, and clot lysis. This review focuses on the TEG®/ROTEM® and important laboratory and patient considerations for interpretation in the ECMO and VAD population. We summarize the adult and pediatric ECMO/VAD literature regarding VET values, VET-platelet mapping, utility over standard laboratory monitoring, and association with outcome measures such as blood product utilization, bleeding, and thrombosis.
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spelling pubmed-91205942022-05-21 Viscoelastic Testing in Pediatric Mechanical Circulatory Support Regling, Katherine Saini, Arun Cashen, Katherine Front Med (Lausanne) Medicine Pediatric mechanical circulatory support can be lifesaving. However, managing anticoagulation is one of the most challenging aspects of care in patients requiring mechanical circulatory support. Effective anticoagulation is even more difficult in pediatric patients due to the smaller size of their blood vessels, increased turbulent flow, and developmental hemostasis. Recently, viscoelastic testing (VET) has been used as a qualitative measure of anticoagulation efficacy in patients receiving extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD). Thromboelastography (TEG®) and thromboelastometry (ROTEM®) provide a global qualitative assessment of hemostatic function from initiation of clot formation with the platelet-fibrin interaction, platelet aggregation, clot strength, and clot lysis. This review focuses on the TEG®/ROTEM® and important laboratory and patient considerations for interpretation in the ECMO and VAD population. We summarize the adult and pediatric ECMO/VAD literature regarding VET values, VET-platelet mapping, utility over standard laboratory monitoring, and association with outcome measures such as blood product utilization, bleeding, and thrombosis. Frontiers Media S.A. 2022-05-06 /pmc/articles/PMC9120594/ /pubmed/35602480 http://dx.doi.org/10.3389/fmed.2022.854258 Text en Copyright © 2022 Regling, Saini and Cashen. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Regling, Katherine
Saini, Arun
Cashen, Katherine
Viscoelastic Testing in Pediatric Mechanical Circulatory Support
title Viscoelastic Testing in Pediatric Mechanical Circulatory Support
title_full Viscoelastic Testing in Pediatric Mechanical Circulatory Support
title_fullStr Viscoelastic Testing in Pediatric Mechanical Circulatory Support
title_full_unstemmed Viscoelastic Testing in Pediatric Mechanical Circulatory Support
title_short Viscoelastic Testing in Pediatric Mechanical Circulatory Support
title_sort viscoelastic testing in pediatric mechanical circulatory support
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120594/
https://www.ncbi.nlm.nih.gov/pubmed/35602480
http://dx.doi.org/10.3389/fmed.2022.854258
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