Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Transfusion. 2022 Apr;62(4):741-750. doi: 10.1111/trf.16830. Epub 2022 Feb 16.
Use of extracorporeal membrane oxygenation (ECMO) is increasing among critically ill adults with cardiac and/or respiratory failure. Use of ECMO is associated with hemostatic alterations requiring use of anticoagulation and blood product support. There are limited guidelines to direct transfusion management in the adult patient supported with ECMO. The objective of this article is to describe (1) the role of the transfusion service in providing transfusion support and current understanding of transfusion thresholds, (2) the complexities of monitoring anticoagulation, and (3) the consideration regarding additional factor concentrates and antifibrinolytics within the context of ECMO support. The information provided should assist ECMO care teams in informing transfusion and anticoagulation practice while highlighting key areas for future research and collaboration.
体外膜肺氧合（ECMO）在患有心源性和/或呼吸衰竭的重症成人中的应用正在增加。ECMO 的使用与止血改变有关，需要使用抗凝和血制品支持。目前针对 ECMO 支持的成年患者，仅有有限的指南来指导输血管理。本文的目的是描述（1）输血科在提供输血支持方面的作用以及目前对输血阈值的理解，（2）监测抗凝的复杂性，以及（3）在 ECMO 支持的背景下考虑其他因子浓缩物和抗纤维蛋白溶解剂。提供的信息应协助 ECMO 护理团队在告知输血和抗凝实践的同时，突出未来研究和合作的重点领域。
