Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study

Nellis, Marianne; Vasovic, Ljiljana V.; Goel, Ruchika; Karam, Oliver

doi:10.3389/fped.2021.673613

Cited by 10 publications

(9 citation statements)

References 21 publications

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“…Many infants with these hemorrhagic complications are treated with FFP and/or cryoprecipitate. [85][86][87][88][89] Neonates undergoing treatment with ECMO have had a higher frequency of intracranial hemorrhage when they had low fibrinogen levels. 90,91 The ELSO guidelines advise for transfusion of plasma or cryoprecipitate to maintain fibrinogen levels above 150 mg/dL.…”

Section: Use O F Cryoprecipitate I N Acquired Coagulation Disordersmentioning

confidence: 99%

Use of Cryoprecipitate in Newborn Infants

Maheshwari¹,

Tyagi²,

Guaragni³

et al. 2023

Newborn

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Cryoprecipitate is a transfusion blood product derived from fresh-frozen plasma (FFP), comprised mainly of the insoluble precipitate that gravitates to the bottom of the container when plasma is thawed and refrozen. It is highly enriched in coagulation factors I (fibrinogen), VIII, and XIII; von Willebrand factor (vWF); and fibronectin. In this article, we have reviewed currently available information on the preparation, properties, and clinical importance of cryoprecipitate in treating critically ill neonates. We have searched extensively in the databases PubMed, Embase, and Scopus after short-listing keywords to describe the current relevance of cryoprecipitate.

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Section: Use O F Cryoprecipitate I N Acquired Coagulation Disordersmentioning

confidence: 99%

Use of Cryoprecipitate in Newborn Infants

Maheshwari¹,

Tyagi²,

Guaragni³

et al. 2023

Newborn

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“…Plasma and/or cryoprecipitate transfusions may be given to a bleeding child on ECMO, to prevent bleeding in a coagulopathic child or to replete fibrinogen. As with all blood components, children on ECMO are exposed to large volumes of plasma and cryoprecipitate with one large database study reporting the use of plasma on one-third of ECMO days and cryoprecipitate on one-sixth [34]. Plasma transfusions have been independently associated with increased in-hospital mortality in adults on ECMO [40].…”

Section: Plasma And/or Cryoprecipitate Transfusionsmentioning

confidence: 99%

“…Platelet transfusions may be given to a child who is bleeding on ECMO, though much more commonly are prescribed to prevent bleeding [33]. Studies of large databases have reported that children on ECMO receive platelet transfusions on 50–67% of all ECMO days; they receive a total median dose of 90 ml/kg of platelet transfusions during their ECMO run [34,35]. Similar to RBC transfusions, platelet transfusions to children and adults supported by ECMO have been independently associated with increased mortality, increased rate of thrombosis, and paradoxically, increased rates of bleeding [5 ▪▪ ,36,37].…”

Section: Transfusionsmentioning

confidence: 99%

Anticoagulation and hemostasis on extracorporeal membrane oxygenation

Carmona

Nellis

Karam

2023

Current Opinion in Pediatrics

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Purpose of reviewThe purpose of this review is to describe the hemostatic changes induced by extracorporeal membrane oxygenation (ECMO), the need to balance the risks of bleeding and clotting with anticoagulation and hemostatic transfusions, and the inherent risks to these interventions.Recent findingsBoth bleeding and clotting are frequent complications of ECMO. To prevent clotting events, virtually, all children are anticoagulated. However, the optimal anticoagulation strategy is unknown. A recent systematic review of observational studies showed that anti-Xa-guided strategies were associated with a two-fold decrease in bleeding and no increase in clotting complications. These results need to be tested in randomized controlled trials. To avoid bleeding events, platelet transfusions are frequently prescribed to children on ECMO. However, platelet transfusions have recently been shown to be independently associated with increased bleeding and clotting. Therefore, the optimal platelet transfusion strategy must be evaluated appropriately.SummaryMost patients on ECMO will develop either a hemorrhagic or thrombotic complication. Balancing these risks involves careful titration of anticoagulation to prevent clotting and hemostatic transfusions to prevent bleeding. As the current level of evidence is low, prospective randomized trials are needed.

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“…Transfused patients received a total of 7 (3-13) plasma units during their ECMO run, equivalent to 21 (10-43) mL/kg of body weight. Per day, when a transfusion was administered, they received 4 (2-6) plasma units (equivalent to 12 [7][8][9][10][11][12][13][14][15][16][17][18][19][20] mL/kg). Most plasma transfusions were given in the first 3 days of ECMO (Supplementary S6, http:// links.lww.com/CCX/B229).…”

Section: Plasma and Procoagulant Product Use In Va-ecmomentioning

confidence: 99%

“…Patients received 5 (3)(4)(5)(6)(7)(8) plasma units in total, equivalent to 17 mL/kg of bodyweight. They received 3 units (2-4) per administered day (equivalent to 9 [6][7][8][9][10][11][12][13][14][15][16][17] mL/kg bodyweight). Most plasma transfusions were administered on the first 2 days of ECMO (Supplementary S6, http:// links.lww.com/CCX/B229).…”

Section: Plasma and Procoagulant Product Use In Vv-ecmomentioning

confidence: 99%

Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices

van Haeren,

Raasveld,

Karami

et al. 2023

Critical Care Explorations

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OBJECTIVES: To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) in patients on ECMO. DESIGN: A prespecified subanalysis of a multicenter retrospective study. Venovenous (VV)-ECMO and venoarterial (VA)-ECMO are analyzed as separate populations, comparing patients with and without bleeding and with and without thrombotic complications. SETTING: Sixteen international ICUs. PATIENTS: Adult patients on VA-ECMO or VV-ECMO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 420 VA-ECMO patients, 59% (n = 247) received plasma, 20% (n = 82) received fibrinogen concentrate, 17% (n = 70) received TXA, and 7% of patients (n = 28) received PCC. Fifty percent of patients (n = 208) suffered bleeding complications and 27% (n = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, p < 0.001), fibrinogen concentrate (28% vs 11%, p < 0.001), and TXA (23% vs 10%, p < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, p = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% (n = 81) received plasma, 6% (n = 12) fibrinogen concentrate, 7% (n = 14) TXA, and 5% (n = 10) PCC. Thirty-nine percent (n = 80) of VV-ECMO patients suffered bleeding complications and 23% (n = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, p < 0.001), fibrinogen concentrate (13% vs 2%, p < 0.01), and TXA (11% vs 2%, p < 0.01). CONCLUSIONS: The majority of patients on ECMO receive transfusions of plasma, procoagulant products, or antifibrinolytics. In a significant part of the plasma transfused patients, this was in the absence of bleeding or prolonged international normalized ratio. This poses the question if these plasma transfusions were administered for another indication or could have been avoided.

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Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study

Cited by 10 publications

References 21 publications

Use of Cryoprecipitate in Newborn Infants

Use of Cryoprecipitate in Newborn Infants

Anticoagulation and hemostasis on extracorporeal membrane oxygenation

Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices

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