title: Severe Thrombocytopenia in Adults with Severe Acute Respiratory Distress Syndrome: Impact of Extracorporeal Membrane Oxygenation Use.
abstract: Extracorporeal membrane oxygenation (ECMO) use is perceived to cause thrombocytopenia (T), but the role of non-ECMO factors in the development of T remains unclear. We sought to evaluate the incidence and factors associated with severe T (platelet count ≤ 50,000/μl) in adults with severe acute respiratory distress syndrome (ARDS) managed with or without ECMO. The ECMO (n = 32) versus the non-ECMO (n = 53) groups had a similar baseline platelet count (214,000 vs. 179,000/μl), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = 0.13), unfractionated heparin (UFH) exposure (p = 0.62), and severe T incidence (25 vs. 19%, p = 0.5). Although the APACHE II score (p = 0.01), presence of liver failure (p = 0.08), and platelet transfusion (p = 0.0009) were different between the severe T (18/85 [21%]) and non-severe T groups (67/85 [79%]), the incidence of septic shock (p = 0.64), heparin infusion use (p = 0.41), exposure to non-heparin T-causing medications (p = 0.77) and ECMO use (p = 0.5) were not. An adjusted multivariate linear regression model revealed that only the APACHE II score was independently associated with the development of severe T (p = 0.01) but use of ECMO was not (p = 0.32) ECMO use may not affect the incidence of severe T among adults with severe ARDS. Larger studies that are prospective in nature are required to confirm this finding.
authors.affiliation: From the *Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York; †School of Pharmacy, Northeastern University, Boston, Massachusetts; ‡Department of Pharmacy Services, Massachusetts General Hospital, Boston, Massachusetts; §College of Pharmacy, King Saud University, Riyahd, Saudi Arabia; ¶Division of Pulmonary, Critical Care Medicine and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts; ‖Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland; and #Tufts CTSI Biostatistics and Epidemiology Research Design Center, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Dzierba
authors.forename: Russel
authors.initials: R
authors.lastname: Roberts
authors.forename: Justin
authors.initials: J
authors.lastname: Muir
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alhammad
authors.forename: Greg
authors.initials: G
authors.lastname: Schumaker
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Clark
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications*; D013921:Thrombocytopenia / Q000209:etiology*