Children Undergoing ECMO Commonly Develop Acquired von Willebrand Disease

Extracorporeal membrane oxygenation (ECMO) provides extended cardiac and respiratory support to patients with inadequate gas exchange and circulation, which are essential for sustaining life; however, the incidence of bleeding complications during ECMO support remains a significant concern. “Acquired von Willebrand disease (AVWD) might contribute to the development of bleeding complications,” investigators of a study published in the Journal of Thrombosis and Haemostasis wrote.

The researchers employed a prospective observational design to investigate the incidence of AVWD and its pattern over the initial 14 days of ECMO support in children, while also exploring the link between AVWD and bleeding issues.

The study enrolled pediatric patients aged ≤17 years who were receiving ECMO support due to severe cardiac and/or pulmonary failure. Blood samples were collected at various intervals: before and after ECMO initiation, daily during ECMO support, and 12 to 24 hours after ECMO cessation. The collected samples were analyzed for von Willebrand factor (VWF) parameters and multimer patterns. Additionally, comprehensive clinical data were gathered for each patient. AVWD was defined based on criteria such as decreased high molecular weight (HMW) multimers or VWF:CB/VWF:Ag and VWF:act/VWF:Ag ratios <0.7.

Of the 50 patients included in the study, 100% developed AVWD during the course of ECMO support. Specific VWF parameters, including HMW multimers, VWF:CB/VWF:Ag ratio, and VWF:act/VWF:Ag ratio exhibited a decline in the initial days of ECMO support, followed by a rapid recovery to baseline levels within 24 hours of ECMO discontinuation.

The incidence and pattern of AVWD were found to be comparable in patients with and without major bleeding complications, suggesting that the development of AVWD might not be the primary driver of significant bleeding events in these cases.

“Children undergoing ECMO support commonly develop AVWD. AVWD develops rapidly after the start of ECMO support and recovers quickly after [the] stop of ECMO. Importantly, AVWD appears to be independent of major bleeding,” the investigators concluded.