PMID- 36090551 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220913 IS - 2296-2360 (Print) IS - 2296-2360 (Electronic) IS - 2296-2360 (Linking) VI - 10 DP - 2022 TI - Hemostasis in neonatal ECMO. PG - 988681 LID - 10.3389/fped.2022.988681 [doi] LID - 988681 AB - Extracorporeal membrane oxygenation (ECMO) is a life-saving support for cardio-respiratory function. Over the last 50 years, the extracorporeal field has faced huge technological progress. However, despite the improvements in technique and materials, coagulation problems are still the main contributor to morbidity and mortality of ECMO patients. Indeed, the incidence and survival rates of the main hemorrhagic and thrombotic complications in neonatal respiratory ECMO are relevant. The main culprit is related to the intrinsic nature of ECMO: the contact phase activation. The exposure of the human blood to the non-endothelial surface triggers a systemic inflammatory response syndrome, which chronically activates the thrombin generation and ultimately leads to coagulative derangements. Pre-existing illness-related hemostatic dysfunction and the peculiarity of the neonatal clotting balance further complicate the picture. Systemic anticoagulation is the management's mainstay, aiming to prevent thrombosis within the circuit and bleeding complications in the patient. Although other agents (i.e., direct thrombin inhibitors) have been recently introduced, unfractionated heparin (UFH) is the standard of care worldwide. Currently, there are multiple tests exploring ECMO-induced coagulopathy. A combination of the parameters mentioned above and the evaluation of the patient's underlying clinical context should be used to provide a goal-directed antithrombotic strategy. However, the ideal algorithm for monitoring anticoagulation is currently unknown, resulting in a large inter-institutional diagnostic variability. In this review, we face the features of the available monitoring tests and approaches, mainly focusing on the role of point-of-care (POC) viscoelastic assays in neonatal ECMO. Current gaps in knowledge and areas that warrant further study will also be addressed. CI - Copyright (c) 2022 Cortesi, Raffaeli, Amelio, Amodeo, Gulden, Manzoni, Cervellini, Tomaselli, Colombo, Araimo, Artoni, Ghirardello, Mosca and Cavallaro. FAU - Cortesi, Valeria AU - Cortesi V AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. AD - Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy. FAU - Raffaeli, Genny AU - Raffaeli G AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. AD - Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy. FAU - Amelio, Giacomo S AU - Amelio GS AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. FAU - Amodeo, Ilaria AU - Amodeo I AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. FAU - Gulden, Silvia AU - Gulden S AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. FAU - Manzoni, Francesca AU - Manzoni F AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. AD - Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy. FAU - Cervellini, Gaia AU - Cervellini G AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. AD - Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy. FAU - Tomaselli, Andrea AU - Tomaselli A AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. AD - Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy. FAU - Colombo, Marta AU - Colombo M AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. AD - Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy. FAU - Araimo, Gabriella AU - Araimo G AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. FAU - Artoni, Andrea AU - Artoni A AD - Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. FAU - Ghirardello, Stefano AU - Ghirardello S AD - Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. FAU - Mosca, Fabio AU - Mosca F AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. AD - Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy. FAU - Cavallaro, Giacomo AU - Cavallaro G AD - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. LA - eng PT - Journal Article PT - Review DEP - 20220826 PL - Switzerland TA - Front Pediatr JT - Frontiers in pediatrics JID - 101615492 PMC - PMC9458915 OTO - NOTNLM OT - anticoagulation management OT - developmental hemostasis OT - neonatal ECMO OT - point-of-care tests OT - thrombosis COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2022/09/13 06:00 MHDA- 2022/09/13 06:01 PMCR- 2022/08/26 CRDT- 2022/09/12 03:45 PHST- 2022/07/07 00:00 [received] PHST- 2022/08/12 00:00 [accepted] PHST- 2022/09/12 03:45 [entrez] PHST- 2022/09/13 06:00 [pubmed] PHST- 2022/09/13 06:01 [medline] PHST- 2022/08/26 00:00 [pmc-release] AID - 10.3389/fped.2022.988681 [doi] PST - epublish SO - Front Pediatr. 2022 Aug 26;10:988681. doi: 10.3389/fped.2022.988681. eCollection 2022.