Prevalence of hematologic complications on extracorporeal membranous oxygenation in critically ill pediatric patients: A systematic review and meta-analysis

Tang, Wen; Zhang, Wenting; Zhang, Jun; Jiang, Kaihua; Ge, Yawen; Zheng, Ai-Bing; Wang, Qiuwei; Xue, Peng; Chen, Honglin

doi:10.1016/j.thromres.2022.12.014

Thrombosis Research

2023

DOI: 10.1016/j.thromres.2022.12.014

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Prevalence of hematologic complications on extracorporeal membranous oxygenation in critically ill pediatric patients: A systematic review and meta-analysis

Wen Tang

Wenting Zhang

Jun Zhang

et al.

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Cited by 2 publications

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“…Anemia is common with ECMO and typically attributed to a combination of circuit-related hemolysis, frequent blood sampling for laboratory monitoring, and an increased risk of bleeding given the use of anticoagulants, consumptive coagulopathy, and thrombocytopenia/platelet dysfunction. 6,7 While bleeding remains a principal cause of anemia in patients on ECMO, the authors attempt to quantify the contribution of other etiologies. They note that in the "non-bleeding" ECMO patients, diagnostic phlebotomy accounted for almost a quarter of blood loss, followed by intravascular hemolysis at 16%.…”

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“…Transfusion of blood products, such as RBCs, plasma, platelets, and cryoprecipitate, while on ECMO occurs for a variety of reasons. Anemia is common with ECMO and typically attributed to a combination of circuit‐related hemolysis, frequent blood sampling for laboratory monitoring, and an increased risk of bleeding given the use of anticoagulants, consumptive coagulopathy, and thrombocytopenia/platelet dysfunction 6,7 . While bleeding remains a principal cause of anemia in patients on ECMO, the authors attempt to quantify the contribution of other etiologies.…”

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Disentangling the causes of RBC loss and anemia in ECMO patients: Some questions answered?

2023

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Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving intervention for children and adults with severe cardiac or respiratory failure. [1][2][3] The use of veno-venous (VV) and veno-arterial (VA) ECMO as a bridge to cardiopulmonary recovery or to heart or lung transplantation has dramatically increased in the last decade. 4 In this issue of TRANSFUSION, Bilodeau et al. seek to characterize and quantify the various causes of red blood cell (RBC) loss in pediatric patients on ECMO. 5 The authors propose the use of the RBC loss index (RLI), a novel metric based upon changes in hematocrit and the volume of transfused RBCs, calculated as mL of RBCs lost per liter of total (patient + circuit) volume per hour. They also propose using RBC extracellular vesicle (REV) generation as a marker of sublethal injury to RBCs during ECMO. The investigators suggest that sublethal RBC damage may stimulate extravascular clearance and eventual RBC loss. We applaud the authors on their effort to provide objective metrics for blood loss as well as RBC injury in children on ECMO, and believe that this article should be of great interest to the readers of TRANSFUSION.Transfusion of blood products, such as RBCs, plasma, platelets, and cryoprecipitate, while on ECMO occurs for a variety of reasons. Anemia is common with ECMO and typically attributed to a combination of circuit-related hemolysis, frequent blood sampling for laboratory monitoring, and an increased risk of bleeding given the use of anticoagulants, consumptive coagulopathy, and thrombocytopenia/platelet dysfunction. 6,7 While bleeding remains a principal cause of anemia in patients on ECMO, the authors attempt to quantify the contribution of other etiologies. They note that in the "non-bleeding" ECMO patients, diagnostic phlebotomy accounted for almost a quarter of blood loss, followed by intravascular hemolysis at 16%. This calculation suggested that a majority (up to 60%) of RBC loss in patients without evidence of bleeding was due to other etiologies. Studies have shown that patients supported with ECMO may inadvertently be exposed to RBC transfusion for the treatment of otherwise mild anemia resulting from blood loss, particularly phlebotomy. Frequent phlebotomy and laboratory sampling can contribute to transfusion requirements in more than 50% of patients and have been the sole reason for at least one transfusion in 40% of patients. 7

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Disentangling the causes of RBC loss and anemia in ECMO patients: Some questions answered?

2023

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Results from 237 extracorporeal membrane oxygenation runs with drowned patients: a nationwide retrospective study

Jasny,

Kloka,

Old

et al. 2023

Crit Care

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Background Drowning is one of the leading causes of death worldwide and presents with a wide range of symptoms, from simple coughing to cardiac or pulmonary failure. In severe cases, extracorporeal membrane oxygenation (ECMO) should be considered as a rescue therapy. Therefore, we sought to analyse ECMO usage, outcomes and predictive factors in drowned patients. Methods The Federal Statistical Office of Germany provided the study data. The patients included experienced drowning (ICD T75.1) and ECMO (OPS 8–852.0, 8–852.3) between 2007 and 2020. All age groups were included. Mortality was calculated for the total population and for ECMO patients. A multiple logistic regression model for ECMO patients was applied to account for predefined patient characteristics and complications. Results Of 12,354 patients who were hospitalised due to drowning, 237 patients (1.9%) received ECMO. Hospital mortality was 14.1% (n = 1741) overall and 74.7% (n = 177) for ECMO patients. In-hospital mortality was positively associated with cardiopulmonary resuscitation (CPR) before admission (odds ratio [OR] 4.49, 1.31–15.39) and in-hospital CPR (OR 6.28, 2.76–14.31). Stroke (OR 0.14, 0.02–0.96) and drug abuse (OR 0.05, 0.01–0.45) were negatively associated with in-hospital mortality. Neither the ECMO mode nor the patient’s age and sex had statistically significant effects on survival. Conclusion This study indicates that survival in drowned patients who receive ECMO is lower than previously reported. The proportion of paediatric patients was also smaller than expected. As the effects of different ECMO modes on mortality remain unclear, the need for further study remains great.

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Prevalence of hematologic complications on extracorporeal membranous oxygenation in critically ill pediatric patients: A systematic review and meta-analysis

Cited by 2 publications

References 58 publications

Disentangling the causes of RBC loss and anemia in ECMO patients: Some questions answered?

Disentangling the causes of RBC loss and anemia in ECMO patients: Some questions answered?

Results from 237 extracorporeal membrane oxygenation runs with drowned patients: a nationwide retrospective study

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