Abstract
Introduction
Bleeding and thrombosis are major causes of morbidity and mortality in pediatric extracorporeal membrane oxygenation (ECMO), yet their evolving, time-dependent risks remain poorly defined. This study evaluated clinical predictors of bleeding and thrombotic events using time-to-event analysis.
Methods
A retrospective cohort study was conducted using the Pediatric ECMO Outcomes Registry (PEDECOR) from October 2011 to September 2024. Patients aged ≤18 years undergoing their first ECMO run were included. Two time-varying Cox proportional hazards models assessed associations between prior complications and time to first bleed or thrombosis, adjusting for clinical and ECMO-related variables.
Results
Among 1444 patients, median age was 0.4 years (IQR: 0.0–4.4), and 53.6% were male. Bleeding occurred in 65% and thrombosis in 28%. Time to first bleeding events had a median of 2 days (IQR: 0–4) while time to first thrombosis had a median of 3 days (IQR: 2–6). Prior thrombosis was associated with lower early bleeding risk (HR: 0.39, 95% CI: 0.25–0.62, p < 0.001), which reversed over time (interaction HR: 1.44, 95% CI: 1.08–1.92, p = 0.013; crossover at 12.4 days). Similarly, prior bleeding was associated with reduced early thrombosis risk (HR: 0.49, 95% CI: 0.34–0.71, p < 0.001), but reversed over time (interaction HR: 1.63, 95% CI: 1.26–2.11, p < 0.001; crossover at 4.3 days). Central cannulation, cardiac surgery, and non-pulmonary indications were associated with bleeding; sepsis was associated with thrombosis. Anticoagulant type and sex were not significant.
Conclusions
Bleeding and thrombosis are common and time-dependent in pediatric ECMO. These findings support dynamic anticoagulation strategies tailored to evolving risk.
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
