title: Decreasing transfusion exposure risk during extracorporeal membrane oxygenation (ECMO).
abstract: Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy for neonatal pulmonary hypertension but carries a significant risk for transfusion-related complications. Packed red blood cell (PRBC) and platelet exposure were quantified and reviewed in 17 ECMO survivors prior (Group I, n = 9) and subsequent to (Group II, n = 8) changes in transfusion protocols. Blood product requirements included ECMO circuit priming, maintenance of haematocrit > 0.40 or platelet count > 50 x 10(9)/l, and colloid volume expansion. Group I was exposed to 13.8 +/- 10.2 (x +/- SD) different PRBC units. In Group II, multiple transfusions from single donor units decreased exposure 71% to 3.9 +/- 0.7 units (P < 0.05). Decreases in blood withdrawn (11%) and transfusion volume (7%) were coincident with a 15% reduction in mean bypass time. Platelet volume transfusion decreased from 159 +/- 213 to 93 +/- 64 ml using volume-reduced platelet packs. Total transfusion exposure decreased 59% from 20.8 +/- 17.8 units to 8.6 +/- 2.4 donor units. No transfusion complications occurred during the aggregate 1,926 h on bypass. We conclude that neonates on ECMO have a significant transfusion exposure risk increasing with prolonged duration of ECMO therapy. In addition we noted that concentrated platelet packs decreased transfusion volume by 41%, and multiple PRBC transfusions from single donor units decreased donor exposure by 71% while both strategies decreased the overall transfusion exposure risk by 59%.
authors.affiliation: Division of Pediatric Surgery, UCLA Medical Centre.
authors.forename: H S
authors.initials: HS
authors.lastname: Bjerke
authors.forename: R E
authors.initials: RE
authors.lastname: Kelly
authors.forename: R P
authors.initials: RP
authors.lastname: Foglia
authors.forename: L
authors.initials: L
authors.lastname: Barcliff
authors.forename: L
authors.initials: L
authors.lastname: Petz
mesh_terms: D016913:Blood Component Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000151:congenital; D007231:Infant, Newborn; D001239:Inhalation; D008297:Male; D008470:Meconium; D017713:Platelet Transfusion; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D018805:Sepsis / Q000150:complications; D065227:Transfusion Reaction