From the Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, Baltimore, MD.
ASAIO J. 2022 Oct 1;68(10):1249-1255. doi: 10.1097/MAT.0000000000001643. Epub 2021 Dec 28.
Thrombocytopenia is common during extracorporeal membrane oxygenation (ECMO), and platelets are sometimes transfused to meet arbitrary goals. We performed a retrospective cohort study of veno-arterial (VA) ECMO patients from a single academic medical center and explored the relationship between platelet transfusion and in-hospital mortality using multivariable logistic regression. One hundred eighty-eight VA ECMO patients were included in the study. Ninety-one patients (48.4%) were transfused platelets during ECMO. Patients who received platelet transfusion had more coronary artery disease, lower platelet counts at cannulation, higher predicted mortality, lower nadir platelet counts, more ECMO days, and more red blood cell (RBC) and plasma transfusion. Mortality was 19.6% for patients who received no platelets, 40.8% for patients who received 1-3 platelets, and 78.6% for patients who received 4 or more platelets ( P < 0.001). After controlling for confounding variables including baseline severity of illness, central cannulation, postcardiotomy status, RBC and plasma transfusion, major bleeding, and total ECMO days, transfusion of 4 or more platelets remained associated with in-hospital mortality; OR = 4.68 (95% CI = 1.18-27.28), P = 0.03. Our findings highlight the need for randomized controlled trials that compare different platelet transfusion triggers, so that providers can better understand when platelet transfusion is indicated in VA ECMO patients.
血小板减少症在体外膜肺氧合（ECMO）期间很常见，有时会输注血小板以达到任意目标。我们对来自单一学术医疗中心的静脉-动脉（VA）ECMO 患者进行了回顾性队列研究，并使用多变量逻辑回归探讨了血小板输注与住院死亡率之间的关系。本研究纳入了 188 例 VA ECMO 患者。91 例（48.4%）患者在 ECMO 期间输注了血小板。输注血小板的患者更易患有冠状动脉疾病，置管时血小板计数更低，预测死亡率更高，血小板计数最低，ECMO 天数更多，以及输注更多的红细胞（RBC）和血浆。未输注血小板的患者死亡率为 19.6%，输注 1-3 个血小板的患者死亡率为 40.8%，输注 4 个或更多血小板的患者死亡率为 78.6%（P < 0.001）。在控制了包括基线疾病严重程度、中心置管、心脏手术后状态、RBC 和血浆输注、大出血和总 ECMO 天数在内的混杂变量后，输注 4 个或更多血小板仍与住院死亡率相关；OR = 4.68（95%CI = 1.18-27.28），P = 0.03。我们的研究结果强调了需要进行随机对照试验，以比较不同的血小板输注触发因素，从而使提供者能够更好地了解在 VA ECMO 患者中何时需要输注血小板。
