Perfusion NewswireBlood ManagementAntithrombin III Administration in Neonates with Congenital Diaphragmatic Hernia During the First Three Days of Extracorporeal Membrane Oxygenation
Antithrombin III Administration in Neonates with Congenital Diaphragmatic Hernia During the First Three Days of Extracorporeal Membrane Oxygenation
PURPOSE: To evaluate the effect of Antithrombin III (ATIII) on blood product requirement in neonates receiving extracorporeal membrane oxygenation (ECMO).
METHODS: A retrospective case control study of neonates presenting with or without congenital diaphragmatic hernia (CDH) requiring ECMO between 2006 and 2010 was performed. Patient demographics, laboratory data, and information on blood products administered were compared in patients treated before (n=37) and after (n=38) a protocol for antithrombin-III (ATIII) administration was implemented.
RESULTS: During the first three days on ECMO patients with CDH received less fresh frozen plasma (FFP) and platelets after ATIII administration was introduced (78.1 ± 19.2 ml/kg vs. 27.8 ± 6.2 ml/kg, p<0.007 and 67.8 ± 8.6 ml/kg vs. 47.8 ± 8.4 ml/kg, p=0.05 respectively), while FFP and platelet administration in patients without CDH was not different between the two periods. Patients both with and without CDH received less packed red blood cell (PRBC) transfusions after the ATIII protocol was introduced (230 ± 51.5 ml/kg vs. 73.8 ± 9.7 ml/kg, p<0.002 and 173.2 ± 22.2 ml/kg vs. 66.0 ± 6.6 ml/kg, p<0.001, respectively). Finally, cryoprecipitate administered was not different in patients with and without CDH between the two periods (13 ± 2.9 ml/kg vs. 15.9 ± 7.2 ml/kg, p=NS and 6.1 ± 1.8 ml/kg vs. 3.4 ± 0.6 ml/kg, p=NS, respectively).
CONCLUSIONS: Introduction of routine ATIII administration was associated with decreases in FFP, platelet, and PRBC exposure in neonates with CDH and decreases in PRBC transfusions in neonates without CDH during the first three days of ECMO support.
In this review, we discuss the history of the TAH, its development and clinical application, implications for anaesthetic management, published outcomes and the future outlook for TAHs.
We investigated whether a high bolus dose of cisatracurium (8x ED95) given at induction can provide muscle relaxation for the major part of a cardiac procedure with hypothermic cardiopulmonary bypass, avoid important postoperative residual curarization and cause no waste of product.