Blood Product Utilization in Patients With COVID-19 on ECMO

George, Timothy J.; Sheasby, Jenelle; Shih, Emily; Lilly, Jeffrey C; Harness-Brumley, Cayce L.; Taylor, Jeff E.; Curry, Matthew W; Erwin, Gary E.; Vaquera, Key; Myers, David P.; DiMaio, J. Michael

doi:10.1016/j.jss.2022.02.016

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…One of this study’s strengths is the inclusion of platelets, cryoprecipitate, and FFP utilization, which has not been reported in the literature to the authors’ knowledge. Many institutions, including our own, transfuse RBCs based on hemoglobin levels without well-established transfusion thresholds for platelets, cryoprecipitate and FFP, and may result in excessive transfusion of additional blood products (24). These results underscore that a well-defined restrictive transfusion protocol for hemoglobin, platelets, and fibrinogen can effectively decrease RBC, platelets, cryoprecipitate, and FFP blood product usage.…”

Section: Discussionmentioning

confidence: 99%

“…These structural alterations contribute to the prothrombotic characteristic of stored RBCs and may explain the increased risk of thrombosis (3, 19, 20, 23). In addition, given the profound respiratory failure in venovenous ECMO patients and circulatory failure in venoarterial ECMO patients, increased transfusions may heighten the risk of transfusion-related complications, such as transfusion-related acute lung injury and transfusion-associated circulatory overload (4, 23, 24).…”

Section: Discussionmentioning

confidence: 99%

“…Because this study was nonrandomized, there may exist several biases that influence our results, including selection bias, confounding bias, and evolution in clinical management over the course of the 2-year investigation. In addition, the onset of COVID-19, which coincided with the implementation of the restrictive protocol, represents a possible source of confounding bias as COVID-19 infection has been established to increase the number of days on ECMO and blood product requirements (24). Furthermore, it is important to note that transfusion rates are inherently constrained for cardiac surgery patients, a demographic that contributes a significant portion of venoarterial ECMO cases, potentially introducing another source of confounding bias.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Extracorporeal Membrane Oxygenation Patient Outcomes Following Restrictive Blood Transfusion Protocol

Braaten,

Dillon,

Wothe

et al. 2023

Critical Care Explorations

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OBJECTIVES: To investigate the effect of a restrictive blood product utilization protocol on blood product utilization and clinical outcomes. DESIGN: We retrospectively reviewed all adult extracorporeal membrane oxygenation (ECMO) patients from January 2019 to December 2021. The restrictive protocol, implemented in March 2020, was defined as transfusion of blood products for a hemoglobin level less than 7, platelet levels less than 50, and/or fibrinogen levels less than 100. Subgroup analysis was performed based on the mode of ECMO received: venoarterial ECMO, venovenous ECMO, and ECMO support following extracorporeal cardiopulmonary resuscitation (ECPR). SETTING: M Health Fairview University of Minnesota Medical Center. PATIENTS: The study included 507 patients. INTERVENTIONS: One hundred fifty-one patients (29.9%) were placed on venoarterial ECMO, 70 (13.8%) on venovenous ECMO, and 286 (56.4%) on ECPR. MEASUREMENTS AND MAIN RESULTS: For patients on venoarterial ECMO (48 [71.6%] vs. 52 [63.4%]; p = 0.374), venovenous ECMO (23 [63.9%] vs. 15 [45.5%]; p = 0.195), and ECPR (54 [50.0%] vs. 69 [39.2%]; p = 0.097), there were no significant differences in survival on ECMO. The last recorded mean hemoglobin value was also significantly decreased for venoarterial ECMO (8.10 [7.80–8.50] vs. 7.50 [7.15–8.25]; p = 0.001) and ECPR (8.20 [7.90–8.60] vs. 7.55 [7.10–8.88]; p < 0.001) following implementation of the restrictive transfusion protocol. CONCLUSIONS: These data suggest that a restrictive transfusion protocol is noninferior to ECMO patient survival. Additional, prospective randomized trials are required for further investigation of the safety of a restrictive transfusion protocol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Extracorporeal Membrane Oxygenation Patient Outcomes Following Restrictive Blood Transfusion Protocol

Braaten,

Dillon,

Wothe

et al. 2023

Critical Care Explorations

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“…9 These new practices appear to be safe with comparable complication rates. 4,[10][11][12] Limited studies in neonates have demonstrated similar outcomes with lower transfusion thresholds during ECMO. 13 A recent study of 110 neonates receiving ECMO support demonstrated that both RBC and platelet volume were directly associated with neonatal mortality during ECMO.…”

Section: Introductionmentioning

confidence: 99%

“…A growing appreciation for transfusion practices and mortality on ECMO has led many centers to adjust transfusion practices in an effort to lower blood product exposure 9 . These new practices appear to be safe with comparable complication rates 4,10–12 . Limited studies in neonates have demonstrated similar outcomes with lower transfusion thresholds during ECMO 13 .…”

Section: Introductionmentioning

confidence: 99%

Red blood cell volume, but not platelet or plasma volume is associated with mortality in neonatal ECMO

et al. 2022

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Background: Blood product transfusions are necessary for critically ill neonates on extracorporeal membrane oxygenation (ECMO). Transfusions are administered in response to unstudied arbitrary thresholds and may be associated with adverse outcomes. The objective of this study was to identify relationships between blood product components and mortality in neonates receiving ECMO support for respiratory indications.Study Design and Methods: A retrospective review of neonates receiving ECMO for respiratory indications from 2002 to 2019 from a single quaternary-referral neonatal intensive care unit (NICU). Demographic and outcome data and transfusion volume (ml/kg/day) were harvested

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Bleeding Complications in COVID-19 Critically Ill ARDS Patients Receiving VV-ECMO Therapy

Flinspach,

Bobyk,

Zacharowski

et al. 2023

JCM

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Veno-venous extracorporeal membrane oxygenation (VV-ECMO) therapy is rapidly expanding worldwide, yet this therapy has a serious risk of bleeding. Whether coagulation-activating viral infections such as COVID-19 may have an impact on the risk of bleeding is largely unknown. This study conducted a monocentric investigation of severely affected COVID-19 patients receiving VV-ECMO therapy with regard to the occurrence and possible influences of minor and major bleeding and transfusion requirements. Among the 114 included study patients, we were able to assess more than 74,000 h of VV-ECMO therapy. In these, 103 major bleeding events and 2283 minor bleeding events were detected. In total, 1396 red blood concentrates (RBCs) were administered. A statistically significant correlation with the applied anticoagulation or demographic data of the patients was not observed. Contrary to the frequently observed thromboembolic complications among COVID-19 patients, patients with VV-ECMO therapy, even under low-dose anticoagulation, show a distinct bleeding profile, especially of minor bleeding, with a substantial need for blood transfusions. COVID-19 patients show a tendency to have frequent bleeding and require repeated RBC transfusions during VV-ECMO. This fact might not be solely explained by the mechanical alteration of ECMO or anticoagulation.

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Blood Product Utilization in Patients With COVID-19 on ECMO

Cited by 6 publications

References 15 publications

Extracorporeal Membrane Oxygenation Patient Outcomes Following Restrictive Blood Transfusion Protocol

Extracorporeal Membrane Oxygenation Patient Outcomes Following Restrictive Blood Transfusion Protocol

Red blood cell volume, but not platelet or plasma volume is associated with mortality in neonatal ECMO

Bleeding Complications in COVID-19 Critically Ill ARDS Patients Receiving VV-ECMO Therapy

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