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Published on: October 24, 2018
Clinical outcomes in critically ill children on extracorporeal membrane oxygenation with severe thrombocytopenia
Sonia Labarinas1, Kalpana Norbisrath1, Dana Johnson1
1Children's Heart Institute, Pediatric Cardiac Critical Care, Advanced Cardiopulmonary Therapies and Transplantation, University of Texas- Health Science Center at Houston, Houston, TX, USA.
Insights
A restrictive platelet transfusion strategy in children on extracorporeal membrane oxygenation (ECMO) did not increase bleeding or ECMO duration. However, severe thrombocytopenia was linked to higher in-hospital mortality rates.
Area of Science:
- Pediatrics
- Critical Care Medicine
- Hematology
Background:
- International guidelines recommend maintaining platelet counts between 50-100 × 109 cells/L during extracorporeal membrane oxygenation (ECMO).
- Platelet transfusions are common in ECMO patients, yet bleeding remains a significant complication, affecting up to 70% of these individuals.
Purpose of the Study:
- To investigate the outcomes of critically ill children experiencing severe thrombocytopenia (platelet count < 50 × 109 cells/L) while on ECMO.
- To assess the association between severe thrombocytopenia and bleeding, transfusion frequency, ECMO duration, and mortality.
Main Methods:
- A single-center retrospective study included critically ill children on ECMO from January 2018 to December 2022.
- Data collected included platelet counts (measured four times daily), platelet transfusions, bleeding, hemolysis, clotting events, ECMO duration, and mortality.
- Analysis focused on events within 6 hours following platelet transfusions and the correlation between time with severe thrombocytopenia and outcomes.
Main Results:
- Severe thrombocytopenia was observed in 56% of recorded platelet counts among 54 ECMO patients.
- Severe thrombocytopenia was not significantly associated with increased bleeding within 6 hours post-transfusion (18% vs 20%, p = .95).
- Patients with severe thrombocytopenia received more frequent platelet transfusions (18% vs 11%, p = .001) and had a higher in-hospital mortality rate (p = .003).
Conclusions:
- A restrictive platelet transfusion strategy in pediatric ECMO patients is not linked to increased bleeding or ECMO duration.
- While not directly causing bleeding, severe thrombocytopenia in this population is associated with higher in-hospital mortality.
- Further multicenter research is warranted to confirm the optimal platelet transfusion strategy in pediatric ECMO.
Abstract:
IntroductionAs international guidelines suggest keeping the platelet count between 50 and 100 × 109 cells/L in children on extracorporeal membrane oxygenation (ECMO), platelet transfusions are administered to two-thirds of ECMO days, and up to 70% of these patients still bleed. We aim to describe outcomes in critically ill children who develop severe thrombocytopenia on ECMO.MethodsSingle-center retrospective study, enrolling critically ill children on ECMO admitted at Children's Memorial Hermann, TX, between 1/2018 and 12/2022, with at least one platelet count below 50 × 109 cells/L (severe thrombocytopenia). Platelet counts were measured four times a day. We report platelet transfusion, bleeding, hemolysis, and clotting events within 6 h after transfusion, as well as ECMO duration and mortality.ResultsWe enrolled 54 patients representing 337 ECMO days and 1190 platelet counts. Median weight was 3.7 kg and 54% were male. Severe thrombocytopenia was observed in 56% of platelet counts. Severe thrombocytopenia was not associated with bleeding in the subsequent 6 h (18% vs 20%, p = .95), but was associated with more frequent platelet transfusions (18% vs 11%, p = .001). There was no correlation between time spent with severe thrombocytopenia and the duration of ECMO (R2 = 0.03). While the time spent with severe thrombocytopenia was not associated with on-ECMO mortality rate (p = .36), there was an association with in-hospital mortality rate (p = .003).ConclusionsOur results indicate a restrictive platelet transfusion strategy is not associated with higher proportions of subsequent bleeding, duration of ECMO, or on-ECMO mortality rate. Multicenter studies are needed to evaluate further the appropriateness of this strategy.
