Consumption of blood products during mechanical circulatory support in children: comparison between ECMO and a pulsatile ventricular assist device.
OBJECTIVE
Different mechanical circulatory support (MCS) systems are used in children with intractable heart failure. However, the need for anticoagulation leads to hemorrhage with subsequent use of blood products. We compared the coagulation disorders and the need for blood products in children treated either with extracorporeal membrane oxygenation (ECMO) or with the Berlin Heart pulsatile pneumatic ventricular assist device.


METHODS
We retrospectively reviewed the first 8-day course of 64 children who were on MCS for more than 2 days between 1990 and 2002. Thirty children (median age 7.4 years, weight 25.5 kg) received Berlin Heart support and 34 children (median age 1.8 years, weight 9.2 kg) ECMO. Anticoagulation was accomplished by continuous infusion of heparin. Red blood cell count, platelet count, aPTT, AT III, fibrinogen, and ACT were measured regularly. Depending on blood loss and the coagulation disorder, red blood cells, fresh frozen plasma, platelets, and AT III were substituted.


RESULTS
There were no preoperative differences in hematological parameters between the two groups. In the Berlin Heart group platelet transfusion was 4.3 ml x kg x day vs 24.6 ml x kg x day in the ECMO group. Red blood cell substitution was 17.2 vs 60.3 ml.kg.day. Fresh frozen plasma substitution was 8.5 ml x kg x day vs 46.9 ml x kg x day (P<0.001). Even in the congenital heart defect subgroups, when MCS was implanted without recent cardiotomy, the differences were significant. Nevertheless, the mean daily values for hemoglobin, platelets, and fibrinogen were lower in the ECMO group. There was lower overall mortality in the Berlin Heart group.


CONCLUSIONS
Compared to ECMO, use of the Berlin Heart in children results in less blood loss and lower consumption of red blood cells, platelets, and fresh frozen plasma.
Department of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. stiller@dhzb.de
Brigitte
B
Stiller
Julia
J
Lemmer
Frank
F
Merkle
Vladimir
V
Alexi-Meskishvili
Yuguo
Y
Weng
Michael
M
Hübler
Andreas
A
Koster
Thorsten
T
Drews
Peter E
PE
Lange
Roland
R
Hetzer
D000293:Adolescent; D000991:Antithrombins / Q000032:analysis; D015415:Biomarkers / Q000097:blood*; D006348:Cardiac Surgical Procedures; D002648:Child; D004864:Equipment and Supplies / Q000592:standards*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006836:Hydro-Lyases / Q000097:blood; D008297:Male; D010976:Platelet Count; D011182:Postoperative Care; D012189:Retrospective Studies
D000991:Antithrombins; D015415:Biomarkers; D006454:Hemoglobins; D005340:Fibrinogen; D006836:Hydro-Lyases; C045581:lactate dehydratase