AIM  To evaluate the efficiency of activated partial thromboplastin time (aPTT) combined with activated coagulation time (ACT) for screening bleeding complications in children during extracorporeal membrane oxygenation (ECMO) after cardiac surgery.

  METHODS  The clinical data of children (aged 6 months to 6 years old) who received ECMO support after cardiac surgery in Fuwai Hospital from January 2010 to October 2020 were retrospectively collected. The selected population usually measured aPTT and ACT at the same time every 1-3 hours during ECMO. Bleeding events in children during ECMO support were defined according to the Extracorporeal Life Support Organization (ELSO) anticoagulation guidelines. Pearson correlation was used to evaluate the correlation between ACT and aPTT, linear by linear association method was used to analyze whether the combined indicator of ACT and aPTT had a linear trend with the bleeding events during ECMO and logistic regression was used to combine the indicators of aPTT and ACT. ROC was used to evaluate the sensitivity and specificity of the combined indicator in diagnosing bleeding complications in children during ECMO after cardiac surgery and AUC was calculated to evaluate its accuracy.

  RESULTS  A total of 58 children were enrolled and divided into bleeding group (n=39) and non-bleeding group (n=19) according to the definition of bleeding events. Univariate analysis showed that compared with children in the non-bleeding group, children in the bleeding group had lower red blood cell counts (P<0.05), hemoglobin concentration (P<0.01) and hematocrit (P<0.05) on the day of ECMO installation. The transfusions of fresh frozen plasma (P<0.05) and fibrinogen (P<0.05) in the bleeding group were relatively high and the proportion of exploratory thoracotomy for hemostasis was significantly high (P<0.01). There was a moderate degree of correlation between ACT and aPTT (r=0.558, P<0.01). With the increase of values of ACT and aPTT, there was a linear trend of bleeding events in the study population during ECMO (P<0.01). The indicator of aPTT value combined with ACT value was used to screen bleeding events and its AUC was equal to 0.757.

  CONCLUSION  aPTT combined with ACT is an effective method for screening bleeding complications in children during ECMO after cardiac surgery and this method has good accuracy.