Marianne E Nellis1, Heidi Dalton2, Oliver Karam3. 1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY. 2. Adult and Pediatric ECLS, INOVA Fairfax Hospital, Falls Church, VA. 3. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA.
Abstract
OBJECTIVES: To evaluate the association between bleeding from chest tubes and clinical outcomes in children supported by extracorporeal membrane oxygenation. DESIGN: Secondary analysis of a large observational cohort study. SETTING: Eight pediatric institutions within the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Collaborative Pediatric Critical Care Research Network. PATIENTS: Critically ill children supported by extracorporeal membrane oxygenation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Daily chest tube bleeding, results from hemostatic assays, transfusion volumes, 90-day PICU-free days, and mortality were collected prospectively by trained bedside extracorporeal membrane oxygenation specialists and research coordinators. Extracorporeal membrane oxygenation was employed in the care of 514 consecutive patients. Sixty percent of patients had at least one episode of chest tube bleeding (median chest tube blood volume over the entire extracorporeal membrane oxygenation course was 123 mL/kg [interquartile range, 47-319 mL/kg]). Twenty-six percent had at least 1 day of bleeding from the chest tube greater than 100 mL/kg/d. The number of days with chest tube bleeding greater than 60 mL/kg/d was independently associated with increased in-hospital mortality (adjusted odds ratio, 1.43; 95% CI, 1.05-1.97; p = 0.02) and decreased PICU-free days (beta coefficient, -4.2; 95% CI, -7.7 to -0.6; p = 0.02). The total amount of bleeding from chest tube were independently associated with increased mortality (per mL/kg/extracorporeal membrane oxygenation run; adjusted odds ratio, 1.002; 95% CI, 1.000-1.003; p = 0.04). Fibrinogen, weight, indication for extracorporeal membrane oxygenation, and need for hemodialysis were independently associated with chest tube bleeding, whereas platelet count, coagulation tests, heparin dose, and thrombotic events were not. CONCLUSIONS: In children supported by extracorporeal membrane oxygenation, chest tube bleeding above 60 mL/kg/d was independently associated with worse clinical outcome. Low fibrinogen was independently associated with chest tube bleeding, whereas platelet count and hemostatic tests were not. Further research is needed to evaluate if interventions to prevent or stop chest tube bleeding influence the clinical outcome.
OBJECTIVES: To evaluate the association between bleeding from chest tubes and clinical outcomes in children supported by extracorporeal membrane oxygenation. DESIGN: Secondary analysis of a large observational cohort study. SETTING: Eight pediatric institutions within the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Collaborative Pediatric Critical Care Research Network. PATIENTS: Critically ill children supported by extracorporeal membrane oxygenation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Daily chest tube bleeding, results from hemostatic assays, transfusion volumes, 90-day PICU-free days, and mortality were collected prospectively by trained bedside extracorporeal membrane oxygenation specialists and research coordinators. Extracorporeal membrane oxygenation was employed in the care of 514 consecutive patients. Sixty percent of patients had at least one episode of chest tube bleeding (median chest tube blood volume over the entire extracorporeal membrane oxygenation course was 123 mL/kg [interquartile range, 47-319 mL/kg]). Twenty-six percent had at least 1 day of bleeding from the chest tube greater than 100 mL/kg/d. The number of days with chest tube bleeding greater than 60 mL/kg/d was independently associated with increased in-hospital mortality (adjusted odds ratio, 1.43; 95% CI, 1.05-1.97; p = 0.02) and decreased PICU-free days (beta coefficient, -4.2; 95% CI, -7.7 to -0.6; p = 0.02). The total amount of bleeding from chest tube were independently associated with increased mortality (per mL/kg/extracorporeal membrane oxygenation run; adjusted odds ratio, 1.002; 95% CI, 1.000-1.003; p = 0.04). Fibrinogen, weight, indication for extracorporeal membrane oxygenation, and need for hemodialysis were independently associated with chest tube bleeding, whereas platelet count, coagulation tests, heparin dose, and thrombotic events were not. CONCLUSIONS: In children supported by extracorporeal membrane oxygenation, chest tube bleeding above 60 mL/kg/d was independently associated with worse clinical outcome. Low fibrinogen was independently associated with chest tube bleeding, whereas platelet count and hemostatic tests were not. Further research is needed to evaluate if interventions to prevent or stop chest tube bleeding influence the clinical outcome.
Authors: Marianne E Nellis; Marisa Tucci; Jacques Lacroix; Philip C Spinella; Kelly D Haque; Arabela Stock; Marie E Steiner; E Vincent S Faustino; Nicole D Zantek; Peter J Davis; Simon J Stanworth; Jill M Cholette; Robert I Parker; Pierre Demaret; Martin C J Kneyber; Robert T Russell; Paul A Stricker; Adam M Vogel; Ariane Willems; Cassandra D Josephson; Naomi L C Luban; Laura L Loftis; Stéphane Leteurtre; Christian F Stocker; Susan M Goobie; Oliver Karam Journal: Crit Care Med Date: 2019-12 Impact factor: 7.598
Authors: Jill M Cholette; Jennifer A Muszynski; Juan C Ibla; Sitaram Emani; Marie E Steiner; Adam M Vogel; Robert I Parker; Marianne E Nellis; Melania M Bembea Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.971
Authors: Ashish A Ankola; David K Bailly; Ron W Reeder; Katherine Cashen; Heidi J Dalton; Stephen J Dolgner; Myke Federman; Rod Ghassemzadeh; Adam S Himebauch; Asavari Kamerkar; Josh Koch; Joseph Kohne; Margaret Lewen; Neeraj Srivastava; Renee Willett; Peta M A Alexander Journal: Front Cardiovasc Med Date: 2022-01-13
Authors: Ryan Closson; Elizabeth Mauer; Arabela Stock; Jeffrey D Dayton; Damien J LaPar; Maria C Walline; Marianne E Nellis Journal: Crit Care Explor Date: 2020-08-05