Minifee P K, Daeschner C W, Griffin M P, Allison P L, Zwischenberger J B
Department of Surgery, University of Texas Medical Branch, Galveston 77550.
J Pediatr Surg. 1990 Jan;25(1):38-42. doi: 10.1016/s0022-3468(05)80161-7.
Extracorporeal membrane oxygenation (ECMO) has been successful treatment (80% survival) in over 2,000 neonates with severe respiratory failure (80% predicted mortality without ECMO). Neonates on ECMO require frequent blood product replacement, which increases donor exposure (DE) and the risk of transfusion related complications. Successful, widespread usage of ECMO in neonatal respiratory failure is placing increased numbers of surviving infants at risk for acute and long-term transfusion related problems. We assessed DE rates in 21 consecutive neonatal ECMO survivors. In the first 12 patients packed red blood cell (PRBC) transfusions were administered as 10 mL/kg body weight for hematocrit less than 45%. PRBC exchange transfusions were used in patients with hematocrit less than 45% and hypervolemia. Fresh frozen plasma (FFP) and cryoprecipitate (CRYO) infusions were used empirically for evidence of hemorrhage. DE rates (donors per ECMO day, mean +/- SD) were: PRBC (2.8 +/- 0.6), FFP/CRYO (0.5 +/- 0.7), and platelet (2.0 +/- 1.0), with a total donor exposure rate of 5.3 +/- 2.0 donors per ECMO day. Mean duration of ECMO was 4.6 +/- 2.0 days and total DE per infant was 22.8 +/- 9.5 donors per ECMO run. In a protocol (n = 9) to minimize DE risks, exchange transfusions were eliminated and PRBC transfusion volumes were increased to 15 mL/kg. Empiric use of FFP and CRYO was discontinued. The blood bank divided standard units of PRBCs into four aliquots and dispensed each aliquot sequentially before dispensing blood from another unit.(ABSTRACT TRUNCATED AT 250 WORDS)
体外膜肺氧合（ECMO）已成功治疗了2000多名患有严重呼吸衰竭的新生儿（80%存活），若不使用ECMO，预计死亡率达80%。接受ECMO治疗的新生儿需要频繁更换血液制品，这增加了供体暴露（DE）以及输血相关并发症的风险。ECMO在新生儿呼吸衰竭中的成功广泛应用，使越来越多的存活婴儿面临急性和长期输血相关问题的风险。我们评估了21例连续的新生儿ECMO存活者的供体暴露率。在前12例患者中，当血细胞比容低于45%时，以10 mL/kg体重输注浓缩红细胞（PRBC）。血细胞比容低于45%且伴有血容量过多的患者采用PRBC换血疗法。根据出血情况经验性使用新鲜冰冻血浆（FFP）和冷沉淀（CRYO）。供体暴露率（每ECMO日的供体数，均值±标准差）为：PRBC（2.8±0.6），FFP/CRYO（0.5±0.7），血小板（2.0±1.0），每ECMO日的总供体暴露率为5.3±2.0个供体。ECMO的平均持续时间为4.6±2.0天，每名婴儿每次ECMO治疗的总供体暴露为22.8±9.5个供体。在一项旨在降低供体暴露风险的方案（n = 9）中，取消了换血疗法，PRBC输注量增加至15 mL/kg。停止了FFP和CRYO的经验性使用。血库将标准单位的PRBC分成四份，在从另一单位取血前依次分发每份。（摘要截选至250字）
