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Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
How we provide transfusion support for neonatal and pediatric patients on extracorporeal membrane oxygenation
Shan Yuan1, Elsa Tsukahara, Kim De La Cruz
1Division of Transfusion Medicine, City of Hope National Medical Center, Duarte, California, USA.
Insights
This study outlines a protocol for transfusion support in neonatal and pediatric patients undergoing extracorporeal membrane oxygenation (ECMO). It emphasizes multidisciplinary collaboration to improve patient outcomes and resource management during ECMO therapy.
Area of Science:
- Pediatric Critical Care Medicine
- Transfusion Medicine
- Cardiopulmonary Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is vital for neonatal and pediatric patients with severe cardiopulmonary failure.
- Successful ECMO requires integrated care from critical care, perfusion, and transfusion services.
- ECMO patients need substantial and often urgent blood product transfusions.
Purpose of the Study:
- To describe a developed protocol for transfusion support in ECMO patients.
- To address communication and logistical challenges in providing timely blood products.
- To enhance patient outcomes and optimize resource utilization in ECMO care.
Main Methods:
- Developed a multidisciplinary protocol for transfusion support.
- Implemented strategies for identifying and stratifying ECMO candidates.
- Streamlined blood product ordering and communication processes.
- Focused on improving blood product availability and turnaround times.
Main Results:
- The protocol aims to ensure efficient and adequate transfusion support.
- Enhanced collaboration between services is a key component.
- Improved logistics are expected to positively impact patient care.
Conclusions:
- A structured, multidisciplinary approach to transfusion support is crucial for ECMO.
- The described protocol can optimize resource management and patient outcomes.
- This experience offers valuable insights for transfusion and critical care specialists.
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.
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