Blood use during extracorporeal membrane oxygenation

Abstract

An analysis of the transfusion records of 91 neonatal patients subjected to extracorporeal membrane oxygenation (ECMO) is reported. Mean daily blood usage was 250 mL of red cells (RBCs), 80 mL of fresh-frozen plasma, and 2 units of platelets. Average time on ECMO was 4.6 days. Group O or ABO type-specific RBCs and group AB or ABO type-specific plasma products and platelets were transfused. RBCs were not washed, and neither RBCs nor other components were tested for anticytomegalovirus (CMV) or irradiated. No cases of posttransfusion CMV infection or graft-versus-host disease were observed. Hemolysis in eight patients was traced to occlusions in the ECMO circuit. All but three patients survived ECMO. Contrary to a previous report, an active ECMO program for neonatal patients imposes a minimal burden on the hospital transfusion service.

Multicenter Analysis of Platelet Transfusion Usage Among Neonates on Extracorporeal Membrane Oxygenation

“…6,9,14,15 These studies, as well as our observations, clearly demonstrate that donor exposures can be significantly decreased by transfusion practices in the different institutions. Until safer alternatives to platelet transfusions are available for neonates on ECMO, every effort should be made to minimize donor exposures.…”

High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation

“…A possible explanation for the fact that this RCT could not show benefit from ECMO is that 22 bleeding complications occurred in their LFPPV-ECCO 2 R-treated patients leading to termination of extracorporeal respiratory support in seven patients. Available literature suggests that bleeding complications are frequently related to high-dose heparinization [15,[78][79][80][81][82][83][84]. Heparincoated circuits and membrane oxygenators were used in all of our ECMO-treated patients and we observed a much lower incidence of bleeding complications.…”

Comparison of Coagulation Parameters, Anticoagulation, and Need for Transfusion in Patients on Interventional Lung Assist or Veno-Venous Extracorporeal Membrane Oxygenation

“…Both iLA and miniaturized ECMO systems have been shown to provide sufficient extracorporeal gas transfer to maintain a protective ventilation (17,26). However, in the past, the positive effects of a more protective ventilation may have been neutralized by device-related complications-especially thrombosis, bleeding, and necessity of large amounts of transfusions (12,13). Although events of thrombosis and bleeding have been mentioned in some reports (14,27), there has * Only patients requiring more than one MO and extracorporeal support for at least 7 days.…”

“…Data related to anticoagulation, transfusion, and coagulation parameters were collected prospectively by the Regensburg ECMO registry. Except for a higher, sequential organ failure assessment (SOFA) score in the ECMO group (12 [9-15] vs. 11 [7][8][9][10][11][12][13][14], P = 0.007), a better oxygenation, and a lower dosage of vasopressors in the iLA patients, both groups had similar baseline characteristics. No difference was noted in terms of outcome and overall transfusion requirements.…”