AI Article Synopsis
- The study examines the use of various blood products (plasma, fibrinogen concentrate, TXA, and PCC) in patients on extracorporeal membrane oxygenation (ECMO) to achieve better blood clotting balance.
- It analyzes data from a multicenter retrospective study involving adult patients on VA-ECMO and VV-ECMO, identifying complications related to bleeding and thrombosis.
- Results indicate a higher use of transfusions in patients with bleeding complications, revealing trends in treatment that suggest a need for reevaluation of current transfusion practices in ECMO patients.
Article Abstract
Objectives: To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) in patients on ECMO.
Design: A prespecified subanalysis of a multicenter retrospective study. Venovenous (VV)-ECMO and venoarterial (VA)-ECMO are analyzed as separate populations, comparing patients with and without bleeding and with and without thrombotic complications.
Setting: Sixteen international ICUs.
Patients: Adult patients on VA-ECMO or VV-ECMO.
Interventions: None.
Measurements And Main Results: Of 420 VA-ECMO patients, 59% ( = 247) received plasma, 20% ( = 82) received fibrinogen concentrate, 17% ( = 70) received TXA, and 7% of patients ( = 28) received PCC. Fifty percent of patients ( = 208) suffered bleeding complications and 27% ( = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, < 0.001), fibrinogen concentrate (28% vs 11%, < 0.001), and TXA (23% vs 10%, < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% ( = 81) received plasma, 6% ( = 12) fibrinogen concentrate, 7% ( = 14) TXA, and 5% ( = 10) PCC. Thirty-nine percent ( = 80) of VV-ECMO patients suffered bleeding complications and 23% ( = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, < 0.001), fibrinogen concentrate (13% vs 2%, < 0.01), and TXA (11% vs 2%, < 0.01).
Conclusions: The majority of patients on ECMO receive transfusions of plasma, procoagulant products, or antifibrinolytics. In a significant part of the plasma transfused patients, this was in the absence of bleeding or prolonged international normalized ratio. This poses the question if these plasma transfusions were administered for another indication or could have been avoided.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443757 | PMC |
| http://dx.doi.org/10.1097/CCE.0000000000000949 | DOI Listing |
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