TY - JOUR
T1 - Changes in von Willebrand Factor Multimers, Concentration, and Function During Pediatric Extracorporeal Membrane Oxygenation
AU - Van Den Helm, Suelyn
AU - Letunica, Natasha
AU - Barton, Rebecca
AU - Weaver, Asami
AU - Yaw, Hui Ping
AU - Karlaftis, Vasiliki
AU - Mccafferty, Conor
AU - Cai, Tengyi
AU - Newall, Fiona
AU - Horton, Stephen B.
AU - Chiletti, Roberto
AU - Johansen, Amy
AU - Best, Derek
AU - Mckittrick, Joanne
AU - Butt, Warwick
AU - D'Udekem, Yves
AU - Maclaren, Graeme
AU - Linden, Matthew D.
AU - Ignjatovic, Vera
AU - Monagle, Paul
N1 - Funding Information:
Ms. Van Den Helm’s, Ms. Letunica’s, Mr. McCafferty’s, and Drs. Ignjatovic’s and Monagle’s institutions received funding from the Australian National Health and Medical Research Council. Dr. MacLaren disclosed that he serves on the Board of Directors of the Extracorporeal Life Support Organization. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Funding Information:
Supported, in part, by grant from Australian National Health and Medical Research Council, grant 1129317 and Sebia for providing the HYDRASYS 2 analyzer and Hydragel 11 von Willebrand factor multimer kits for this study.
Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - OBJECTIVES: To investigate changes in von Willebrand factor (VWF) concentration, function, and multimers during pediatric extracorporeal membrane oxygenation (ECMO) and determine whether routine monitoring of VWF during ECMO would be useful in predicting bleeding. DESIGN: Prospective observational study of pediatric ECMO patients from April 2017 to May 2019. SETTING: The PICU in a large, tertiary referral pediatric ECMO center. PATIENTS: Twenty-five neonates and children (< 18 yr) supported by venoarterial ECMO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Arterial blood samples were collected within 24 hours pre-ECMO, daily for the first 5 days of ECMO, every second day until decannulation, and 24 hours post-ECMO. The STA R Max analyzer was used to measure VWF antigen (VWF:Ag) and ristocetin cofactor (VWF:RCo) activity. VWF collagen binding (VWF:CB) was measured using an enzyme-linked immunosorbent assay. VWF multimers were measured using the semi-automated Hydragel 11 VWF Multimer assay. Corresponding clinical data for each patient was also recorded. A total of 25 venoarterial ECMO patients were recruited (median age, 73 d; interquartile range [IQR], 3 d to 1 yr). The median ECMO duration was 4 days (IQR, 3-8 d) and 15 patients had at least one major bleed during ECMO. The percentage of high molecular weight multimers (HMWM) decreased and intermediate molecular weight multimers increased while patients were on ECMO, irrespective of a bleeding status. VWF:Ag increased and the VWF:RCo/VWF:Ag and VWF:CB/VWF:Ag ratios decreased while patients were on ECMO compared with the baseline pre-ECMO samples and healthy children. CONCLUSIONS: Neonates and children on ECMO exhibited a loss of HMWM and lower VWF:CB/VWF:Ag and VWF:RCo/VWF:Ag ratios compared with healthy children, irrespective of major bleeding occurring. Therefore, monitoring VWF during ECMO would not be useful in predicting bleeding in these patients and changes to other hemostatic factors should be investigated to further understand bleeding during ECMO.
AB - OBJECTIVES: To investigate changes in von Willebrand factor (VWF) concentration, function, and multimers during pediatric extracorporeal membrane oxygenation (ECMO) and determine whether routine monitoring of VWF during ECMO would be useful in predicting bleeding. DESIGN: Prospective observational study of pediatric ECMO patients from April 2017 to May 2019. SETTING: The PICU in a large, tertiary referral pediatric ECMO center. PATIENTS: Twenty-five neonates and children (< 18 yr) supported by venoarterial ECMO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Arterial blood samples were collected within 24 hours pre-ECMO, daily for the first 5 days of ECMO, every second day until decannulation, and 24 hours post-ECMO. The STA R Max analyzer was used to measure VWF antigen (VWF:Ag) and ristocetin cofactor (VWF:RCo) activity. VWF collagen binding (VWF:CB) was measured using an enzyme-linked immunosorbent assay. VWF multimers were measured using the semi-automated Hydragel 11 VWF Multimer assay. Corresponding clinical data for each patient was also recorded. A total of 25 venoarterial ECMO patients were recruited (median age, 73 d; interquartile range [IQR], 3 d to 1 yr). The median ECMO duration was 4 days (IQR, 3-8 d) and 15 patients had at least one major bleed during ECMO. The percentage of high molecular weight multimers (HMWM) decreased and intermediate molecular weight multimers increased while patients were on ECMO, irrespective of a bleeding status. VWF:Ag increased and the VWF:RCo/VWF:Ag and VWF:CB/VWF:Ag ratios decreased while patients were on ECMO compared with the baseline pre-ECMO samples and healthy children. CONCLUSIONS: Neonates and children on ECMO exhibited a loss of HMWM and lower VWF:CB/VWF:Ag and VWF:RCo/VWF:Ag ratios compared with healthy children, irrespective of major bleeding occurring. Therefore, monitoring VWF during ECMO would not be useful in predicting bleeding in these patients and changes to other hemostatic factors should be investigated to further understand bleeding during ECMO.
KW - child
KW - extracorporeal membrane oxygenation
KW - hemorrhage
KW - infant
KW - newborn
KW - von Willebrand factor
UR - http://www.scopus.com/inward/record.url?scp=85152173306&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000003152
DO - 10.1097/PCC.0000000000003152
M3 - Article
C2 - 36602314
AN - SCOPUS:85152173306
SN - 1529-7535
VL - 24
SP - 268
EP - 276
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 4
ER -