Effect of New Heparin Potency on Activated Clotting Time during Pediatric Cardiac Surgery: A Retrospective Chart Review.

In 2009, the U.S Food and Drug Administration (FDA) announced a two-phase change in unfractionated heparin to reduce contamination and create a new potency reference. The FDA announced the change would bring about a 10% decrease in potency from the old heparin (OH) to new heparin (NH). The purpose of this article is to compare heparin in pediatric patients undergoing cardiac surgery before and after the FDA changes. After Institutional Review Board approval, a retrospective chart review was conducted with pediatric patients (n = 266) undergoing cardiac surgery. All patients received a heparin loading dose of 400 IU/kg and data collected included patient demographics, baseline activated clotting time (ACT), ACT after initial heparin dose, and heparin dose-response. These data were then further broken down into age blocks consisting of neonates (< 1 month), 1-12 months, 1-5 years old, and older than 5 years old. In 17.3% of cases in the NH group, the ACT after the initial heparin dose did not reach the critical value of 400 seconds necessary for initiation of cardiopulmonary bypass (CPB). This is significantly higher than the 8.9% of cases in the OH group (p < .05). There was an overall trend among age groups that the NH was less potent than OH. However, only the 1-5 years of age group showed significance at p < .05. Given the median ACTs 591 seconds for OH and 484 seconds for NH, the calculated percentage difference was 18.1%. The results from this retrospective pediatric chart review indicate that the change in heparin potency greatly deviates from the 10% change reported by the FDA. In conclusion, NH has a trend of lower potency and frequent monitoring is necessary to maintain a safe level of anticoagulation during CPB.

Trends and emerging technologies in extracorporeal life support: results of the 2006 ECLS survey.

Extracorporeal life support (ECLS) is a procedure used to support the failing heart and/or lungs via a heart lung machine. Over 145 institutions perform this practice in the United States with more than 24,000 ECLS cases recorded. While many articles are published each year on common perfusion practice, little information is shared on emerging technologies in ECLS and common practices among perfusionists and ECLS specialists. This article presents our 2006 ECLS survey results and discusses emerging technologies and management topics new to the ECLS arena. ECLS specialists were asked to participate in an online survey. Two hundred twenty-two ECLS specialists responded. This survey suggests positive displacement roller pumps are still the leading pump used for ECLS 122/188 (64.9%). Silicone membrane oxygenators are used by responders 75% of the time for long-term use, while hollow fiber membrane oxygenators are used 44%. Forty-five percent of responders are using heparin or biocoated circuits exclusively, while 14.6% restrict their use to specific subpopulations. The most common coating is heparin coating (67.9%). Activated clotting time (ACT) management is still standard of care for coagulation monitoring (98%), while partial thromboplastin time (PTT) follows at 71.7%. The interquartile range for ACTs is 160-220 seconds and 160-200 seconds with active bleeding. This article suggests ECLS specialists are beginning to incorporate different technology into their practice, such as centrifugal pumps with hollow fiber oxygenators and coated-circuits.