Coagulation factor activity during neonatal extra-corporeal membrane oxygenation

Objective: To ascertain the activity of major coagulation factors during th e first 24 h of extracorporeal membrane oxygenation (ECMO) used to support hypoxaemic neonates. Design and setting: A prospective observational study in a regional centre for ECMO and paediatric cardiac surgery, placing 15-20 neonates on ECMO per year. Patients: Ten neonates receiving ECMO for severe hypoxaemia. Measurement and results: The activity of major clotting factors, of the inh ibitor anti-thrombin III and of markers of blood activation were measured d uring the first 24 h of neonatal extra-corporeal membrane oxygenation (ECMO ) and prior to initiation of ECMO. There was laboratory evidence of factor deficiency and of activation of coagulation at all stages. The initiation o f ECMO leads to an initial worsening of coagulopathy, but factor deficiency and abnormal activation of coagulation is also seen prior to ECMO in these very sick neonates. Conclusion: If factor deficiency is to be avoided a pro-active approach is required to rapidly correct factor activity. This would include the use of fresh frozen plasma. The effect of such an approach on outcome is at vet un certain.