Predictors of bleeding in ECMO patients undergoing surgery

Area of Science:

• Cardiovascular Medicine
• Surgical Critical Care
• Hematology

Background:

• Bleeding is a significant complication of veno-venous extracorporeal membrane oxygenation (vvECMO) therapy in surgical patients.
• Understanding coagulation parameters is crucial for managing bleeding risk during vvECMO.

Purpose of the Study:

• To retrospectively analyze packed red blood cell (PRBC) transfusion amounts and coagulation parameters in surgical patients undergoing vvECMO.
• To identify potential predictors of bleeding in patients requiring surgery during vvECMO.

Main Methods:

• Retrospective analysis of 73 patients undergoing surgery during vvECMO.
• Comparison of coagulation parameters and PRBC transfusion volumes between two groups: <2 PRBCs (Group A) and ≥2 PRBCs (Group B).
• Analysis included hemoglobin, coagulation tests (aPTT, PT/INR, platelets), and fibrinogen levels.

Main Results:

• No significant differences in activated PTT, Quick test, platelet count, or mortality between groups.
• Fibrinogen levels were significantly lower in Group B (245 mg/dL) compared to Group A (353 mg/dL; P=0.004).
• Perioperative transfusion of two or more PRBCs was associated with reduced preoperative fibrinogen levels.

Conclusions:

• Reduced preoperative fibrinogen levels are associated with higher PRBC transfusion requirements in surgical patients on vvECMO.
• Other routine coagulation parameters and lab values analyzed did not show predictive value for bleeding in this cohort.
• This finding may inform transfusion strategies and bleeding risk assessment in surgical vvECMO patients.