How we provide transfusion support for neonatal and pediatric patients on extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) provides lifesaving hemodynamic and respiratory support to neonatal and pediatric patients with a variety of congenital or acquired cardiopulmonary defects. Successful ECMO support requires close collaboration among multiple services, including critical care medicine, perfusion, and transfusion medicine services. Neonatal and pediatric ECMO patients require significant transfusion support, both at the time of cannulation and after the ECMO circuit has been established, often with little advance notice. Thus a number of communication and logistic issues must be addressed through a multidisciplinary approach to ensure both good patient outcome and judicious use of resources. In this article, we describe our protocol for transfusion support for ECMO and potential ECMO patients, which was developed to address a number of issues, including identifying and stratifiying ECMO candidate patients, streamlining the ordering and communication processes, and improving blood product turnaround times and availability. Additional measures of quality improvement are also discussed. As the number of centers performing ECMO procedures remains high, we believe that our experience may be of interest to our colleagues in transfusion medicine and critical care.

How to Guide Transfusion Decision-Making? That Is the Question*

“…The practice evaluated in this report (transfusion to maintain ~ ‘normal’ Hct) is consistent with the Guideline published by the Extracorporeal Life Support Organization (ELSO)[2] and with reports by other ECMO centers[3], though some now target a lower Hct (30%)[4]. The strategic basis for this approach is to maintain an ‘adequate’ RBC mass well above a threshold that may critically limit tissue O 2 delivery.…”

Extracorporeal life support for patients with acute respiratory distress syndrome: report of a Consensus Conference

“…It is therefore necessary to fill the circuit with blood, or fresh plasma, or albumin [44]. Hemofiltration coupled with ECMO allows adjustment of fluid-electrolyte balance and caloric intake [45].…”

Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française

“…Il est donc nécessaire d'assurer le remplissage du circuit soit avec du sang, soit avec du plasma frais, soit avec de l'albumine [44]. Une hémofiltration couplée à l'ECMO permet d'équilibrer la balance hydro-sodée et les apports caloriques [45].…”