Abnormalities of coagulation related to the use of inhaled nitric oxide before extracorporeal membrane oxygenation.

OBJECTIVE: Evaluation of the influence of previous inhaled nitric oxide (iNO) treatment on the occurrence of clotting complications and disseminated intravascular coagulation during extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective study in newborns treated with venoarterial ECMO during a 5-yr period. SETTING: Neonatal intensive care unit of a university medical center. PATIENTS: A total of 59 newborns with severe respiratory insufficiency treated with venoarterial ECMO. INTERVENTIONS: Patients received iNO before ECMO (iNO group) or not (control group). MEASUREMENTS AND MAIN RESULTS: There were no differences between the groups for patient characteristics and medication use before ECMO, except for norepinephrine. After correction for diagnosis and duration of ECMO, significantly more clotting complications and disseminated intravascular coagulation as individual variables were seen in the iNO group. For the combination of clotting complications and disseminated intravascular coagulation, there was a significantly higher prevalence in the iNO group. CONCLUSIONS: In our population, we found a remarkable relationship between clotting complications or disseminated intravascular coagulation and iNO use before ECMO treatment, which needs further prospective research before conclusions can be drawn.

The effect of inhaled nitric oxide on the course of extracorporeal membrane oxygenation and the occurrence of hemorrhagic complications.

This study evaluated the relation between prior inhaled nitric oxide (iNO) and the time to initiation and duration of treatment with veno-arterial extracorporeal membrane oxygenation (ECMO) and the occurrence of hemorrhagic complications. A retrospective study was conducted in 59 human newborns treated for respiratory insufficiency with ECMO over a 5-year period. Patients received iNO before ECMO (iNO group) or not (control group). Both groups were compared for patient characteristics, postnatal age at the initiation of ECMO, duration of ECMO treatment, and hemorrhagic complications. There were no significant differences between the iNO group and the control group for patient characteristics and medication use before the ECMO treatment, except for norepinephrine. There was no significant difference for postnatal age at the initiation of ECMO and mean duration of ECMO treatment. We found no statistically significant difference in hemorrhagic complications between both groups. This persisted after correction for diagnosis and ECMO run-time in linear logistic regression analysis. Inhaled nitric oxide before ECMO did not result in a significant delay in the initiation of ECMO or longer duration of the ECMO. There was no significant relationship between the use of prior iNO and the occurrence of hemorrhagic complications during the ECMO treatment.