Impact of fresh frozen plasma transfusion on mortality in extracorporeal membrane oxygenation

Abstract

Background Patients who receive extracorporeal membrane oxygenation (ECMO) support require substantial transfusions. Red blood cell (RBC) and platelet (PLT) transfusions have been reported to be associated with adverse outcomes in ECMO patients. However, little is known about whether the transfusion of fresh frozen plasma (FFP) is associated with mortality and morbidity among patients receiving ECMO. The aim of this study was to examine the relationship between FFP transfusion and mortality in ECMO patients and assess risk factors for the transfusion of FFP. Methods The clinical parameters of 116 ECMO patients were collected. The machine learning approach of the Boruta algorithm was employed to select the variables associated with ECMO patients' in-hospital mortality. Univariate and multivariate logistic regression analyses were applied to identify the association between the selected variables and in-hospital mortality. Spearman correlation and backwards stepwise multiple linear regression analyses were used to examine parameters contributing to FFP transfusion. Results Among the 116 patients who received ECMO support, the in-hospital mortality was 32.8%. The median FFP (mL/kg/d) transfusion was higher in dead patients (5.07, IQR 1.78–8.90) when compared to alive patients (2.16, IQR 0.79–4.66) ( p = 0.007). After adjustment for confounders, FFP transfusion (mL/kg/d) was associated with in-hospital mortality (OR 1.09, 95% CI, 1.01–1.18; p = 0.035). Further analysis found that higher activated partial thromboplastin time (APTT), higher levels of uric acid (UA) and lower PLT counts were significant risk factors for FFP transfusion, with estimated values of 0.06 (95% CI, 0.02–0.11; p = 0.009), 0.01 (95% CI, 0.00–0.02; p = 0.003) and −0.03 (95% CI, −0.05--0.01; p = 0.007), respectively. Conclusion FFP transfusion is markedly associated with in-hospital mortality among patients receiving ECMO, and higher APTT, higher levels of UA and lower PLT counts are risk factors for FFP transfusion. This suggests that better management of patients' coagulation system and kidney function may reduce the utilization of FFP, thus improving ECMO patient outcomes.

Anticoagulation and hemostasis on extracorporeal membrane oxygenation

“…As with all blood components, children on ECMO are exposed to large volumes of plasma and cryoprecipitate with one large database study reporting the use of plasma on one-third of ECMO days and cryoprecipitate on one-sixth [34]. Plasma transfusions have been independently associated with increased in-hospital mortality in adults on ECMO [40]. In children, daily plasma volume has been independently associated with higher chest tube output and need for RBC transfusion [35].…”

Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices

“…Furthermore, plasma transfusions in critically ill are potentially harmful with adverse reactions such as transfusion-related acute lung injury and transfusion-associated cardiac overload (26). These potentially harmful events could also occur in ECMO patients, indeed plasma transfusions have been associated with mortality in adult ECMO studies (17,27). The actual ELSO guidelines from 2021 recommend an INR threshold of 3.0 for plasma transfusion in nonbleeding ECMO patients (18).…”