PB0627 - Rare case of neonatal coronary artery stenosis and V-A ECMO: Use of bedside TEG and Platelet Mapping to direct management of anticoagulation and antiplatelet drugs.

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

CA

Claudia Alonso Bermejo

PICU Clinical Fellow
Royal Brompton Hospital,Guy's and St Thomas'NHS Foundation Trust

Co-Author(s)

AD

Aiay Desai

Consultant intensivist
Royal Brompton Hospital,Guy's and St Thomas'NHS Foundation Trust
London, England, United Kingdom
LB

Lale Begum

Lead Clinical perfusionist
Royal Brompton Hospital,Guy's and St Thomas'NHS Foundation Trust
London, England, United Kingdom
AF

Alain Fraisse

Consultant pediatric cardiologist
Royal Brompton Hospital,Guy's and St Thomas'NHS Foundation Trust
London, England, United Kingdom
AM

Aoibheann Murphy

Trainee Clinical perfusionist
Royal Brompton Hospital,Guy's and St Thomas'NHS Foundation Trust
London, England, United Kingdom
JW

Justin Wang

Consultant in Pediatric Intensive Care
Royal Brompton Hospital,Guy's and St Thomas'NHS Foundation Trust
London, England, United Kingdom
DF

Diane Frall

Paediatric ECMO Lead Nurse
Royal Brompton Hospital,Guy's and St Thomas'NHS Foundation Trust
London, England, United Kingdom
RL

Rachel Lowden

Clinical specialist
Haemonetics
London, England, United Kingdom

Presenting Author(s)

Maria Rita Peralta, MD

Haemostasis&Thrombosis Consultant
St Thomas Hospital & Royal Brompton Hospital, London, UK
LONDON, England, United Kingdom

Background: Assessing haemostasis in the complex patients of a paediatric intensive care unit (PICU), such as cardiac surgical patients or patients receiving extracorporeal membrane oxygenation (ECMO) presents challenges due to underlying disease or the effects of surgery or treatment, including anticoagulation and antiplatelet administration. These patients require close haemostatic monitoring . The small sample volume needed and the prompt availability of results make viscoelastic methods like Thromboelastography (TEG) attractive for monitoring coagulation in neonates.

Aims: To report a rare case of a neonate with coronary artery stenosis who received veno-arterial (VA) ECMO and had haemostatic management guided by TEG and Platelet mapping.

Methods: Case report. TEG 6s Global Hemostasis Analyzer to analyse TEG and Platelet function. Blood samples taken before ECMO cannulation (baseline), 4hrs after cannulation, and after starting on aspirin on Day 3 of ECMO.

Results: A 3-day-old female term neonate was admitted with myocardial infarction and cardiogenic shock due to a stenotic left main coronary artery (LCA). Patient was initiated on veno-arterial ECMO (V-A ECMO). Anticoagulation on ECMO was achieved with unfractionated heparin. Cardiac catheterisation showed thrombus in LCA, needing balloon dilatation and thrombolysis using intra-coronary tPA. Patient was commenced on aspirin after 72 hours on ECMO. TEG and Platelet Mapping cartridge were used to direct management of anticoagulant and antiplatelet drugs. She had a good clinical outcome with no bleeding complications and was weaned off from ECMO after 7 days.

Conclusion(s): Unfortunately, little published data exists to help determine the role of TEG and platelet mapping in PICU. Our experience would like to shed more light on the utilization of the TEG in this context. Bedside use of TEG and platelet mapping can help judicious management of arterial thrombosis and minimise bleeding complications in neonates on V-A ECMO.