Background: The use of Extracorporeal membrane oxygenation (ECMO) in paediatric patients has greatly increased, the issue of thrombus formation resulting in circuit changeout (CC) remains a significant issue.

Methods : Retrospective analysis of 112 paediatric (<17) patients databases who were cannulated for ECMO at the Royal Brompton Hospital.

Early-findings from a current study being undertaken at the Royal Brompton. To investigate our hypothesis that NO could reduce platelet aggregation blood samples were taken prior to ECMO, 4-hours post-ECMO cannulation, just prior to NO addition, 6- and 24-hours following NO initiation. To investigate the effect that NO had on platelets TEG6 © Haemonetics platelet mapping cartridges were used to allow for a patient-personalised platelet function analysis.

Results : Our retrospective study included 100 patients and demonstrated those who required a CC had decreased survival to de-cannulation, longer duration of ECMO, increased RBC and platelet transfusion. Both the CC group and non-CC group had a significant decline in haemoglobin levels and platelet count following ECMO initiation compared to baseline.

The increased risk associated with CC provides an incentive for novel techniques to decrease the requirement for CC such as the addition of NO to the ECMO sweep gas. This study demonstrated that from baseline the mean ADP inhibition (%) increased, ADP aggregation (%), and maximal amplitude (mm) decreased at 4-hours post-NO initiation. The same trend can be seen for AA. For both, there was an increase in ADP aggregation and maximal amplitude, a decrease in inhibition 24-hours after NO initiation.

Conclusion: Our retrospective study demonstrates that CC decreased the survival to de-cannulation, increased ECMO duration and RBC and platelet transfusions. Although our early findings have too small of a sample size to determine the true effect of NO, it provides rationale for further investigation of its addition to the ECMO sweep gas.