{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:11:24Z","timestamp":1778130684400,"version":"3.51.4"},"reference-count":39,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Jackson Vaughan Critical Care Research Fund at Stanford University"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Bleeding and thrombosis are major causes of morbidity and mortality in pediatric extracorporeal membrane oxygenation (ECMO), yet their evolving, time-dependent risks remain poorly defined. This study evaluated clinical predictors of bleeding and thrombotic events using time-to-event analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted using the Pediatric ECMO Outcomes Registry (PEDECOR) from October 2011 to September 2024. Patients aged \u226418\u00a0years undergoing their first ECMO run were included. Two time-varying Cox proportional hazards models assessed associations between prior complications and time to first bleed or thrombosis, adjusting for clinical and ECMO-related variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1444 patients, median age was 0.4\u00a0years (IQR: 0.0\u20134.4), and 53.6% were male. Bleeding occurred in 65% and thrombosis in 28%. Time to first bleeding events had a median of 2\u00a0days (IQR: 0\u20134) while time to first thrombosis had a median of 3\u00a0days (IQR: 2\u20136). Prior thrombosis was associated with lower early bleeding risk (HR: 0.39, 95% CI: 0.25\u20130.62,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), which reversed over time (interaction HR: 1.44, 95% CI: 1.08\u20131.92,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.013; crossover at 12.4\u00a0days). Similarly, prior bleeding was associated with reduced early thrombosis risk (HR: 0.49, 95% CI: 0.34\u20130.71,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), but reversed over time (interaction HR: 1.63, 95% CI: 1.26\u20132.11,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001; crossover at 4.3\u00a0days). Central cannulation, cardiac surgery, and non-pulmonary indications were associated with bleeding; sepsis was associated with thrombosis. Anticoagulant type and sex were not significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bleeding and thrombosis are common and time-dependent in pediatric ECMO. These findings support dynamic anticoagulation strategies tailored to evolving risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591251365417","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T10:09:59Z","timestamp":1753956599000},"page":"401-413","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal trends and risk factors for bleeding and thrombosis in pediatric ECMO: A multicenter cohort study"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8945-4975","authenticated-orcid":false,"given":"Kevin J.","family":"Dor\u00e9","sequence":"first","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlton M.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy T.","family":"Cornell","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsey K.","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelby","family":"Burk","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura L.","family":"Loftis","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital and Baylor College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Allen","sequence":"additional","affiliation":[{"name":"University of Oklahoma Health Sciences Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melania M.","family":"Bembea","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian M.","family":"Boville","sequence":"additional","affiliation":[{"name":"Helen DeVos Children\u2019s Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1659-6884","authenticated-orcid":false,"given":"Jamie","family":"Furlong-Dillard","sequence":"additional","affiliation":[{"name":"Norton Children\u2019s Hospital and University of Louisville School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santosh","family":"Kaipa","sequence":"additional","affiliation":[{"name":"Children\u2019s Nebraska and University of Nebraska Medical 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Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew P.","family":"Malone","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences"},{"name":"and Arkansas Children\u2019s Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Kline","sequence":"additional","affiliation":[{"name":"Stanford University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Tawfik","sequence":"additional","affiliation":[{"name":"Stanford University School of 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