Weidi Xiao, Nedaa Aldairi, Brian S. Marcus, Matthew Weiss, Allison S. Cowl, Marissa Moncata, Akash Deep, Oliver Karam
Yale University, Yale New Haven Children’s Hospital and Yale School of Medicine. Dr. Sulaiman AlHabib Medical Group. Albert Einstein College of Medicine. Centre Mère-Enfant Soleil du CHU de Québec. Connecticut Children’s Medical Center. King’s College Hospital.
United States, Saudi Arabia, Canada and United Kingdom
World Journal of Pediatric and Congenital Heart Surgery
World J Pediatr Congenit Heart Surg 2026;
DOI: 10.1177/21501351261453052
Abstract
Objectives: Extracorporeal Membrane Oxygenation (ECMO) is associated with high risks of bleeding and clotting. While traditional anticoagulants like heparin and bivalirudin target the coagulation cascade, prostaglandins including PGE1 and PGI2 may offer adjunctive platelet inhibition. This study evaluated whether prostaglandin use modifies the risk of severe bleeding or clotting events in pediatric ECMO patients.
Material and Methods: We used the Pediatric Health Information System database from 2004 to 2025, and included children supported with ECMO. Primary outcomes were severe bleeding and clotting events. Generalized linear mixed model regressions adjusted for site, patient and ECMO data, and pulmonary hypertension.
Results: A total of 22,061 pediatric ECMO patients were included. Pulmonary hypertension was present in 12.4% (2736/22,061). PGE1 and PGI2 were independently associated with increased risk of pulmonary hemorrhage (PGE1: adjusted OR 1.24, P = .003; PGI2: adjusted OR 1.21, P = .047). Conversely, neither PGE1 nor PGI2 were independently associated with intracranial hemorrhage (PGE1: adjusted OR 1.01, P = .92; PGI2: adjusted OR 0.96, P = .79), stroke (PGE1: adjusted OR 1.02, P = .84; PGI2: adjusted OR 0.88, P = .38), or other bleeding or thrombotic events.
Conclusion: In this large multicenter cohort of more than 22,000 pediatric ECMO patients, neither PGE1 nor PGI2-modulated anticoagulation conferred measurable protection against the major bleeding or clotting complications.
Category
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Medical Therapy. Adverse Effects or Lack of Adverse Effects
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
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