Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices.
Maite M T van Haeren, Senta Jorinde Raasveld, Mina Karami, Dinis Dos Reis Miranda, Loes Mandigers, Dieter F Dauwe, Erwin De Troy, Federico Pappalardo, Evgeny Fominskiy, Walter M van den Bergh, Annemieke Oude Lansink-Hartgring, Franciska van der Velde, Jacinta J Maas, Pablo van de Berg, Maarten de Haan, Dirk W Donker, Christiaan L Meuwese, Fabio Silvio Taccone, Lorenzo Peluso, Roberto Lorusso, Thijs S R Delnoij, Erik Scholten, Martijn Overmars, Višnja Ivancan, Robert Bojčić, Jesse de Metz, Bas van den Bogaard, Martin de Bakker, Benjamin Reddi, Greet Hermans, Lars Mikael Broman, José P S Henriques, Jimmy Schenk, Alexander P J Vlaar, Marcella C A Müller
{"title":"Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices.","authors":"Maite M T van Haeren, Senta Jorinde Raasveld, Mina Karami, Dinis Dos Reis Miranda, Loes Mandigers, Dieter F Dauwe, Erwin De Troy, Federico Pappalardo, Evgeny Fominskiy, Walter M van den Bergh, Annemieke Oude Lansink-Hartgring, Franciska van der Velde, Jacinta J Maas, Pablo van de Berg, Maarten de Haan, Dirk W Donker, Christiaan L Meuwese, Fabio Silvio Taccone, Lorenzo Peluso, Roberto Lorusso, Thijs S R Delnoij, Erik Scholten, Martijn Overmars, Višnja Ivancan, Robert Bojčić, Jesse de Metz, Bas van den Bogaard, Martin de Bakker, Benjamin Reddi, Greet Hermans, Lars Mikael Broman, José P S Henriques, Jimmy Schenk, Alexander P J Vlaar, Marcella C A Müller","doi":"10.1097/CCE.0000000000000949","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>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.</p><p><strong>Setting: </strong>Sixteen international ICUs.</p><p><strong>Patients: </strong>Adult patients on VA-ECMO or VV-ECMO.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 420 VA-ECMO patients, 59% (<i>n</i> = 247) received plasma, 20% (<i>n</i> = 82) received fibrinogen concentrate, 17% (<i>n</i> = 70) received TXA, and 7% of patients (<i>n</i> = 28) received PCC. Fifty percent of patients (<i>n</i> = 208) suffered bleeding complications and 27% (<i>n</i> = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, <i>p</i> < 0.001), fibrinogen concentrate (28% vs 11%, <i>p</i> < 0.001), and TXA (23% vs 10%, <i>p</i> < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, <i>p</i> = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% (<i>n</i> = 81) received plasma, 6% (<i>n</i> = 12) fibrinogen concentrate, 7% (<i>n</i> = 14) TXA, and 5% (<i>n</i> = 10) PCC. Thirty-nine percent (<i>n</i> = 80) of VV-ECMO patients suffered bleeding complications and 23% (<i>n</i> = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, <i>p</i> < 0.001), fibrinogen concentrate (13% vs 2%, <i>p</i> < 0.01), and TXA (11% vs 2%, <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 8","pages":"e0949"},"PeriodicalIF":0.0000,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/4b/cc9-5-e0949.PMC10443757.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Explorations","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/CCE.0000000000000949","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
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% (n = 247) received plasma, 20% (n = 82) received fibrinogen concentrate, 17% (n = 70) received TXA, and 7% of patients (n = 28) received PCC. Fifty percent of patients (n = 208) suffered bleeding complications and 27% (n = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, p < 0.001), fibrinogen concentrate (28% vs 11%, p < 0.001), and TXA (23% vs 10%, p < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, p = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% (n = 81) received plasma, 6% (n = 12) fibrinogen concentrate, 7% (n = 14) TXA, and 5% (n = 10) PCC. Thirty-nine percent (n = 80) of VV-ECMO patients suffered bleeding complications and 23% (n = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, p < 0.001), fibrinogen concentrate (13% vs 2%, p < 0.01), and TXA (11% vs 2%, p < 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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