Effect of Platelet Transfusions on Extracorporeal Life Support Oxygenator's Function

Area of Science:

• Pediatric Intensive Care
• Cardiopulmonary Support
• Hematology

Background:

• Bleeding is a frequent complication during extracorporeal membrane oxygenation (ECMO), often necessitating platelet transfusions.
• The impact of these transfusions on ECMO oxygenator function remains poorly understood.

Purpose of the Study:

• To investigate the effect of platelet transfusions on the functional performance of ECMO oxygenators in pediatric patients.

Main Methods:

• A retrospective analysis of children (<18 years) supported by ECMO between 2017-2019.
• Oxygenator function was assessed by post-oxygenator P_O2 and pre- to post-oxygenator pressure gradient (Delta Pressure) before and after platelet transfusions.

Main Results:

• Overall, 235 platelet transfusions in 55 children showed no significant impact on oxygenator function (Delta Pressure: 0.1 mmHg, P_O2: 6 mmHg).
• In a subgroup with the lowest quartile of pre-transfusion oxygenator function, transfusions were associated with significant worsening (Delta Pressure: -5.2 mmHg, P_O2: -118 mmHg).
• Pre-transfusion Delta Pressure and P_O2 independently predicted worsening oxygenator function (AUCs ~0.71-0.72).

Conclusions:

• Platelet transfusions appear safe for ECMO oxygenator function in most pediatric patients.
• Patients with compromised baseline oxygenator function may experience functional decline post-transfusion.
• Further research into anticoagulation strategies around transfusions in this vulnerable subgroup is recommended.