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

Abstract

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.