Predicting Transfusion Requirements During Extracorporeal Membrane Oxygenation.
OBJECTIVE
Patients requiring extracorporeal membrane oxygenation (ECMO) have a well-known bleeding risk and the potential for experiencing possibly fatal thromboembolic complications. Risk factors and predictors of transfusion requirements during ECMO support remain uncertain. The authors hypothesized that compromised organ function immediately before ECMO support will influence transfusion requirements.


METHODS
A prospective observational study.


METHODS
A tertiary, single-institutional university hospital.


METHODS
The study included 40 adult patients requiring ECMO for intractable cardiac and respiratory failure between July 2010 and December 2012. Blood samples were taken before initiation of ECMO (baseline), after 24 and 48 hours on ECMO, and 24 hours after termination of ECMO.


METHODS
None.


RESULTS
Independent of veno-arterial or veno-venous support, 26% of patients required≥2 packed red blood cells per day (PRBC/d) and 74% of patients required<2 PRBC/d during ECMO. Requirements of≥2 PRBC/d during ECMO support were associated with higher creatinine levels and lower prothrombin times (PT, %) at baseline and with impaired platelet function after 24 hours on ECMO. Platelet function, activated by thrombin receptor-activating peptide stimulation, decreased by 30% to 40% over time on ECMO. Receiver operating characteristic curve analysis showed cut-off values for creatinine of 1.49 mg/dL (sensitivity 70%, specificity 70%; area under the curve [AUC] 0.76, 95% confidence interval [CI] 0.58-0.94), for PT of 48% (sensitivity 80%, specificity 59%; AUC 0.69, 95% CI 0.50-0.87), and for thrombin receptor-activating peptide (TRAP) 32 U (sensitivity 90%, specificity 68%; AUC 0.76, 95% CI 0.59-0.93).


CONCLUSIONS
The results of this study demonstrated that increased creatinine levels and lower PT before ECMO and secondary impaired platelet function significantly increased transfusion requirement.
Departments of Anaesthesiology and Critical Care Medicine.
Helmuth
H
Tauber
Pediatrics and Adolescent Medicine.
Werner
W
Streif
Medical Statistics, Informatics and Health Economics.
Josef
J
Fritz
Central Institute for Medical and Chemical Laboratory Diagnostics.
Helmut
H
Ott
Central Institute for Medical and Chemical Laboratory Diagnostics.
Guenter
G
Weigel
Central Institute for Medical and Chemical Laboratory Diagnostics.
Lorin
L
Loacker
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Anneliese
A
Heinz
Departments of Anaesthesiology and Critical Care Medicine; Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: corinna.velik@i-med.ac.at.
Corinna
C
Velik-Salchner
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001803:Blood Transfusion; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D008875:Middle Aged; D015539:Platelet Activation; D011446:Prospective Studies; D013917:Thrombin / Q000096:biosynthesis
D013917:Thrombin
creatinine; extracorporeal membrane oxygenation (ECMO); prothrombin time; thrombin receptor-activating peptide (TRAP); transfusion requirement; whole blood impedance aggregometry