Platelet Transfusion and In-Hospital Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Patients

Abstract

Thrombocytopenia is common during extracorporeal membrane oxygenation (ECMO), and platelets are sometimes transfused to meet arbitrary goals. We performed a retrospective cohort study of veno-arterial (VA) ECMO patients from a single academic medical center and explored the relationship between platelet transfusion and in-hospital mortality using multivariable logistic regression. One hundred eighty-eight VA ECMO patients were included in the study. Ninety-one patients (48.4%) were transfused platelets during ECMO. Patients who received platelet transfusion had more coronary artery disease, lower platelet counts at cannulation, higher predicted mortality, lower nadir platelet counts, more ECMO days, and more red blood cell (RBC) and plasma transfusion. Mortality was 19.6% for patients who received no platelets, 40.8% for patients who received 1-3 platelets, and 78.6% for patients who received 4 or more platelets (P < 0.001). After controlling for confounding variables including baseline severity of illness, central cannulation, postcardiotomy status, RBC and plasma transfusion, major bleeding, and total ECMO days, transfusion of 4 or more platelets remained associated with in-hospital mortality; OR = 4.68 (95% CI = 1.18-27.28), P = 0.03. Our findings highlight the need for randomized controlled trials that compare different platelet transfusion triggers, so that providers can better understand when platelet transfusion is indicated in VA ECMO patients.

Standard Versus Restrictive Transfusion Strategy for Pediatric Cardiac ECLS Patients: Single Center Retrospective Cohort Study

“…33 Further, there is growing evidence of the immunomodulatory and proinflammatory effects of donor platelets and their association with morbidity and mortality. 2,3,34 Similar to PRBC transfusions, observational studies have shown an association between higher volume of platelets transfused and mortality among pediatric ECLS patients. 13,35 A large multicenter point prevalence study showed that more than half of the plasma transfusions received by children on ECLS were prophylactic to prevent bleeding and not to treat ongoing hemorrhage.…”

“…33 Further, there is growing evidence of the immunomodulatory and proinflammatory effects of donor platelets and their association with morbidity and mortality. 2,3,34 Similar to PRBC transfusions, observational studies have shown an association between higher volume of platelets transfused and mortality among pediatric ECLS patients. 13,35…”

Anticoagulation and hemostasis on extracorporeal membrane oxygenation

“…Studies of large databases have reported that children on ECMO receive platelet transfusions on 50–67% of all ECMO days; they receive a total median dose of 90 ml/kg of platelet transfusions during their ECMO run [34,35]. Similar to RBC transfusions, platelet transfusions to children and adults supported by ECMO have been independently associated with increased mortality, increased rate of thrombosis, and paradoxically, increased rates of bleeding [5 ▪▪ ,36,37]. Further studies are needed to prove causation and explore possible mechanisms.…”

Veno-arterial extracorporeal membrane oxygenation without allogeneic blood transfusion: An observational cohort study

“…12 Platelets were generally transfused to keep platelet count above 40 × 10 9 per liter in non-bleeding patients, above 50 × 10 9 per liter in patients with minor bleeding, and above 75 × 10 9 in patients with major bleeding. 13 Bleeding patients who had an international normalized ratio (INR) >1.5 had fresh frozen plasma (FFP) transfused, and those with fibrinogen <200 mg/dL had cryoprecipitate transfused. Platelet, INR, and fibrinogen targets were also subject to adjustment by the critical care team based on patients' clinical status.…”