Predicting Transfusion Requirements During Extracorporeal Membrane Oxygenation

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• 作者：Helmuth Tauber ; MD^* ; Werner Streif ; MD^&dagger ; ; ¹ ; Josef Fritz ; Dipl.Ing^&Dagger ; ; Helmut Ott ; MD^§ ; ; Guenter Weigel ; MD^§ ; ; Lorin Loacker ; MD^§ ; ; Anneliese Heinz ; MD^ǁ ; Corinna Velik-Salchner ; MD^* ; ^ǁ ; ¹ ; ^{corinna.velik@i-med.ac.at" class="auth_mail" title="E-mail the corresponding author}
• 关键词：extracorporeal membrane oxygenation (ECMO) ; transfusion requirement ; creatinine ; prothrombin time ; thrombin receptor-activating peptide (TRAP) ; whole blood impedance aggregometry
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：30
• 期：3
• 页码：692-701
• 全文大小：512 K

文摘

Patients requiring extracorporeal membrane oxygenation (ECMO) have a well-known bleeding risk and the potential for experiencing possibly fatal thromboembolic complications. Risk factors and predictors of transfusion requirements during ECMO support remain uncertain. The authors hypothesized that compromised organ function immediately before ECMO support will influence transfusion requirements.

Design

A prospective observational study.

Setting

A tertiary, single-institutional university hospital.

Participants

The study included 40 adult patients requiring ECMO for intractable cardiac and respiratory failure between July 2010 and December 2012. Blood samples were taken before initiation of ECMO (baseline), after 24 and 48 hours on ECMO, and 24 hours after termination of ECMO.

Interventions

None.

Measurements and Main Results

Independent of veno-arterial or veno-venous support, 26% of patients required≥2 packed red blood cells per day (PRBC/d) and 74% of patients required<2 PRBC/d during ECMO. Requirements of≥2 PRBC/d during ECMO support were associated with higher creatinine levels and lower prothrombin times (PT, %) at baseline and with impaired platelet function after 24 hours on ECMO. Platelet function, activated by thrombin receptor-activating peptide stimulation, decreased by 30% to 40% over time on ECMO. Receiver operating characteristic curve analysis showed cut-off values for creatinine of 1.49 mg/dL (sensitivity 70%, specificity 70%; area under the curve [AUC] 0.76, 95% confidence interval [CI] 0.58-0.94), for PT of 48% (sensitivity 80%, specificity 59%; AUC 0.69, 95% CI 0.50-0.87), and for thrombin receptor-activating peptide (TRAP) 32 U (sensitivity 90%, specificity 68%; AUC 0.76, 95% CI 0.59-0.93).

Conclusions

The results of this study demonstrated that increased creatinine levels and lower PT before ECMO and secondary impaired platelet function significantly increased transfusion requirement.