Addison Samuel D, Buck Marcia L, Fang Gary Y, Gangemi James J, Kaufman David A
Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia.
Department of Pharmacy Services, University of Virginia Children's Hospital, Charlottesville, Virginia.
Transfusion. 2017 Jun;57(6):1391-1395. doi: 10.1111/trf.14076. Epub 2017 Mar 16.
Activation and consumption of platelets (PLT) and clotting factors along with hemolysis occurs when blood contacts the extracorporeal life support (ECLS) circuit and its components.
The objective was to examine the effects of reducing ECLS circuit volume by decreasing tubing length and changing components on blood product usage in neonatal and pediatric patients. Blood product administration was analyzed in 40 consecutive patients who required ECLS for respiratory or cardiac failure before (PRE) and after (POST) changes in circuit design and components.
The total circuit volume was reduced from 500 mL (PRE) to 275 mL (POST). In the POST group, total blood product volume usage was 58% lower compared to the PRE group (81 mL/kg/day vs. 191 mL/kg/day, p = 0.003), 65% lower for fresh-frozen plasma (FFP; 15 mL/kg/day vs. 43 mL/kg/day, p = 0.001), and PLT volumes trended lower. In the subgroup of infants with respiratory or cardiac failure, there was a 55% reduction of a total blood product replacement (61 mL/kg/day vs. 136 mL/kg/day, p = 0.008), red blood cell (RBC) use was 61% lower (28 mL/kg/day vs. 71 mL/kg/day, p < 0.049), and there was a 73% reduction in FFP use (11 mL/kg/day vs. 41 mL/kg/day, p < 0.001). In the subgroup of postoperative infants, there was a 25% decrease in RBC use (86 mL/kg/day vs. 115 mL/kg/day, p = 0.03).
Decreasing the ECLS circuit volume by reducing the tubing length and changing the components was associated with a significant reduction in blood product usage.
当血液与体外生命支持（ECLS）回路及其组件接触时，血小板（PLT）和凝血因子会被激活并消耗，同时会发生溶血。
目的是研究通过缩短管路长度和更换组件来减少ECLS回路容积对新生儿和儿科患者血液制品使用的影响。对40例因呼吸或心力衰竭而需要ECLS的连续患者在回路设计和组件改变之前（PRE）和之后（POST）的血液制品使用情况进行了分析。
总回路容积从500 mL（PRE）降至275 mL（POST）。在POST组中，血液制品总体积使用量比PRE组低58%（81 mL/kg/天 vs. 191 mL/kg/天，p = 0.003），新鲜冰冻血浆（FFP）低65%（15 mL/kg/天 vs. 43 mL/kg/天，p = 0.001），PLT体积呈下降趋势。在呼吸或心力衰竭的婴儿亚组中，血液制品总替代量减少了55%（61 mL/kg/天 vs. 136 mL/kg/天，p = 0.008），红细胞（RBC）使用量低61%（28 mL/kg/天 vs. 71 mL/kg/天，p < 0.049），FFP使用量减少了73%（11 mL/kg/天 vs. 41 mL/kg/天，p < 0.001）。在术后婴儿亚组中，RBC使用量减少了25%（86 mL/kg/天 vs. 115 mL/kg/天，p = 0.03）。
通过缩短管路长度和更换组件来减少ECLS回路容积与血液制品使用量的显著减少相关。
