This study describes the use of bivalirudin in children on extracorporeal membrane oxygenation (ECMO). Pediatric patients receiving bivalirudin were compared to patients receiving heparin as the anticoagulant on ECMO. Data was collected for children under 18 years of age supported by ECMO from January 2016 to December 2019. Data collected included demographics, diagnosis, ECMO indication, type, and duration, indication for bivalirudin use, dose range, activated partial thromboplastin time (aPTT) levels, minor and major bleeding, hemolysis, and mortality. Forty pediatric patients received ECMO; eight received bivalirudin primarily for anticoagulation. The median age was 4 months (IQR 0.5, 92) in the heparin cohort, 0.6 months (IQR 0.0, 80.0) in the primary bivalirudin cohort. The indication for ECMO was respiratory in 5 patients (18%) in the heparin group versus 6 (75%) in the primary bivalirudin group, cardiac in 18 (67%) in heparin versus 1 (12.5%) in primary bivalirudin, and extracorporeal-cardiopulmonary resuscitation (E-CPR) in 4 (15%) in heparin versus 1 (12.5%) in primary bivalirudin. Bivalirudin was the initial anticoagulant for eight patients (66.6%) while three (25%) were switched due to concern for heparin-induced thrombocytopenia (HIT) and one (8%) for heparin resistance. The median time to achieve therapeutic aPTT was 14.5 hours compared to 12 hours in the heparin group. Sixty-five percent of aPTT values in the bivalirudin and 44% of values in the heparin group were in the therapeutic range in the first 7 days. Patients with primary bivalirudin use had significantly lower dose requirement at 12 (p = 0.003), 36 (p = 0.007), and 48 (p = 0.0002) hours compared to patients with secondary use of bivalirudin. One patient (12.5%) had major bleeding, and two patients (25%) required circuit change in the primary bivalirudin cohort. Bivalirudin may provide stable and successful anticoagulation in children. Further large, multicenter studies are needed to confirm these findings.

本研究描述了比伐卢定在儿童体外膜肺氧合 (ECMO) 中的应用。将接受比伐卢定的儿科患者与接受肝素作为 ECMO 抗凝剂的患者进行比较。收集了 2016 年 1 月至 2019 年 12 月接受 ECMO 支持的 18 岁以下儿童的数据。收集的数据包括人口统计学、诊断、ECMO 适应症、类型和持续时间、比伐卢定使用适应症、剂量范围、活化部分凝血活酶时间 (aPTT)水平、小出血和大出血、溶血和死亡率。40 名儿科患者接受了 ECMO；8 名接受比伐卢定主要用于抗凝。肝素队列中的中位年龄为 4 个月（IQR 0.5, 92），主要比伐卢定队列中的中位年龄为 0.6 个月（IQR 0.0, 80.0）。ECMO 的指征是肝素组 5 例患者 (18%) 与主要比伐卢定组 6 例 (75%) 呼吸系统患者、肝素组 18 例患者 (67%) 与主要比伐卢定组 1 例 (12.5%) 心脏患者和体外-心肺复苏术 (E-CPR) 在肝素组中有 4 例 (15%) 而在初级比伐卢定组中有 1 例 (12.5%)。比伐卢定是 8 名患者 (66.6%) 的初始抗凝剂，3 名 (25%) 因担心肝素诱导的血小板减少症 (HIT) 和 1 名 (8%) 因肝素抵抗而更换。达到治疗性 aPTT 的中位时间为 14.5 小时，而肝素组为 12 小时。前 7 天，比伐卢定组 65% 的 aPTT 值和肝素组 44% 的值在治疗范围内。主要使用比伐卢定的患者在 12 岁时的剂量需求显着降低 (p = 0. 003)、36 (p = 0.007) 和 48 (p = 0.0002) 小时与二次使用比伐卢定的患者相比。一名患者 (12.5%) 出现大出血，两名患者 (25%) 需要在主要比伐卢定队列中改变回路。比伐卢定可为儿童提供稳定且成功的抗凝作用。需要进一步的大型多中心研究来证实这些发现。