Blood transfusion requirements and independent predictors of increased transfusion requirements among adult patients on extracorporeal membrane oxygenation – a single centre experience

Ang, Ai Leen; Teo, Diana; Lim, Chong Hee; Leou, Konstantinos; Tien, Sim Leng; Koh, Mickey B.C.

doi:10.1111/j.1423-0410.2008.01110.x

Cited by 63 publications

(78 citation statements)

References 12 publications

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“…ECMO patients often required multiple transfusions [38,39], which may convey an increased risk of transfusion related complications. Previous studies in neonates and animals have demonstrated increases in lipid peroxidation after PRBC transfusions [40][41][42][43].…”

Section: Discussionmentioning

confidence: 99%

The impact of acute lung injury, ECMO and transfusion on oxidative stress and plasma selenium levels in an ovine model

McDonald

Fung

Shekar

et al. 2015

Journal of Trace Elements in Medicine and Biology

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The purpose of this study was to determine the effects of smoke induced acute lung injury (S-ALI), extracorporeal membrane oxygenation (ECMO) and transfusion on oxidative stress and plasma selenium levels. Forty ewes were divided into (i) healthy control (n=4), (ii) S-ALI control (n=7), (iii) ECMO control (n=7), (iv) S-ALI+ECMO (n=8) and (v) S-ALI+ECMO+packed red blood cell (PRBC) transfusion (n=14). Plasma thiobarbituric acid reactive substances (TBARS), selenium and glutathione peroxidase (GPx) activity were analysed at baseline, after smoke injury (or sham) and 0.25, 1, 2, 6, 7, 12 and 24h after initiation of ECMO. Peak TBARS levels were similar across all groups. Plasma selenium decreased by 54% in S-ALI sheep (1.36±0.20 to 0.63±0.27μmol/L, p<0.0001), and 72% in sheep with S-ALI+ECMO at 24h (1.36±0.20 to 0.38±0.19, p<0.0001). PRBC transfusion had no effect on TBARS, selenium levels or glutathione peroxidase activity in plasma. While ECMO independently increased TBARS in healthy sheep to levels which were similar to the S-ALI control, the addition of ECMO after S-ALI caused a negligible increase in TBARS. This suggests that the initial lung injury was the predominant feature in the TBARS response. In contrast, the addition of ECMO in S-ALI sheep exacerbated reductions in plasma selenium beyond that of S-ALI or ECMO alone. Clinical studies are needed to confirm the extent and duration of selenium loss associated with ECMO.

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Section: Discussionmentioning

confidence: 99%

The impact of acute lung injury, ECMO and transfusion on oxidative stress and plasma selenium levels in an ovine model

McDonald

Fung

Shekar

et al. 2015

Journal of Trace Elements in Medicine and Biology

View full text Add to dashboard Cite

show abstract

“…Fresh frozen plasma is widely used to control bleeding disorders, requiring up to 14 plasma units per ECMO day. 9,12 This study evaluates a protocol for the scheduled determination of acquired bleeding disorders and the substitution of blood products as well as coagulation factor concentrates to predefined target values, even in the absence of clinicial bleeding signs. This target-controlled regimen is compared to a coagulation management performed previously, which was based mainly on clinical bleeding signs as a trigger for the administration of blood products.…”

Section: Introductionmentioning

confidence: 99%

Identification of acquired coagulation disorders and effects of target-controlled coagulation factor substitution on the incidence and severity of spontaneous intracranial bleeding during veno-venous ECMO therapy

et al. 2015

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“…As the whole system has a biocompatible BIOLINE coating, a pronounced systemic anticoagulation was unnecessary without any thromboembolic complications. This decreased the rate of blood transfusions, which had been considerably higher in previous studies, despite the fact that the current study included patients with multiple trauma and thrombocytopenia 15,16 . The rate of hemorrhagic complications was markedly reduced, which makes its implementation possible in patients with a risk of bleeding, which had been traditionally contraindications for ECMO therapy.…”

Section: Commentmentioning

confidence: 77%

First experience with the new portable extracorporeal membrane oxygenation system Cardiohelp for severe respiratory failure in adults

et al. 2012

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Background: Over the last decade, technical improvements in extracorporeal membrane oxygenation (ECMO) equipment have reduced procedure-related complications and have made ECMO an effective option for patients with acute respiratory distress syndrome (ARDS) if conventional therapy fails. Methods: In this report, we present our early experience with the Cardiohelp, a new portable miniaturized ECMO system, in 22 consecutive patients with ARDS. All patients were placed on venovenous ECMO. Cannulas were inserted percutaneously, employing the Seldinger technique. Data were collected prospectively. Results: The median patient age was 47 years (36 to 61). Fifteen patients from regional hospitals were too unstable for conventional transport and were placed on Cardiohelp at the referring hospital and then transported to our institution. The patients were transported by ambulance (n=2) or helicopter (n=13) over a distance of 50-250 km. Cardiohelp support resulted in immediate improvement of gas exchange and highly protective ventilation. The median duration of support was 13 days (8 to 19). An exchange of the device was necessary in 9 patients. Sixteen patients (72.7%) were successfully weaned from ECMO and fifteen patients (68.2%) survived. Device-related complications were not observed. Conclusions:The compact portable ECMO device Cardiohelp is a highly effective method to secure vital gas exchange and to reduce further ventilator-induced lung injury in patients with acute respiratory failure. Crucial technical innovations and ease of device transport and implantation allow location-independent stabilization with consecutive inter-hospital transfer.

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Blood transfusion requirements and independent predictors of increased transfusion requirements among adult patients on extracorporeal membrane oxygenation – a single centre experience

Cited by 63 publications

References 12 publications

The impact of acute lung injury, ECMO and transfusion on oxidative stress and plasma selenium levels in an ovine model

The impact of acute lung injury, ECMO and transfusion on oxidative stress and plasma selenium levels in an ovine model

Identification of acquired coagulation disorders and effects of target-controlled coagulation factor substitution on the incidence and severity of spontaneous intracranial bleeding during veno-venous ECMO therapy

First experience with the new portable extracorporeal membrane oxygenation system Cardiohelp for severe respiratory failure in adults

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