Clinical outcomes in critically ill children on extracorporeal membrane oxygenation with severe thrombocytopenia.
Introduction: As 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...
| Publicado en: | Perfusion Vol. 40; no. 3; pp. 590 - 599 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Sage Publications, Ltd.
Apr2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=184006174&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 184006174 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02676591 31J jtl: Perfusion issn: 02676591 maglogo: N pubinfo: dt: Apr2025 vid: 40 iid: 3 pid: 33180 pub: Sage Publications, Ltd. place: <Blank> artinfo: ui: 184006174 176620550 184006174 184006174 10.1177/02676591241247981 184006174 ppf: 590 ppct: 9 formats: tig: atl: Clinical outcomes in critically ill children on extracorporeal membrane oxygenation with severe thrombocytopenia. aug: au: Labarinas, Sonia Norbisrath, Kalpana Johnson, Dana Meliones, Jon Greenleaf, Christopher Salazar, Jorge Karam, Oliver affil: Children's Heart Institute, Pediatric Cardiac Critical Care, Advanced Cardiopulmonary Therapies and Transplantation, University of Texas- Health Science Center at Houston, Houston, TX, USA sug: subj: Thrombocytopenia Therapy Severity of Illness Critically Ill Patients In Infancy and Childhood Extracorporeal Membrane Oxygenation Methods Treatment Outcomes Human Texas Male Female Infant, Newborn Infant Prospective Studies Comparative Studies Retrospective Design Academic Medical Centers Descriptive Statistics Confidence Intervals Odds Ratio Chi Square Test Mann-Whitney U Test Pearson's Correlation Coefficient Data Analysis Software Regression Platelet Count Platelet Transfusion Treatment Duration Hospital Mortality Hemorrhage Intensive Care Units, Pediatric Length of Stay Thrombocytopenia Epidemiology Extracorporeal Membrane Oxygenation Mortality Infant, Newborn: birth-1 month Infant: 1-23 months Male Female ab: Introduction: As 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. Methods: Single-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. Results: We 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). Conclusions: Our 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. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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