Worku Elliott T, Win April M, Parmar Dinesh, Anstey Chris, Shekar Kiran
Adult Intensive Care Services, The Prince Charles Hospital, Chermside, QLD 4032, Australia.
School of Medicine, University of Queensland, St Lucia, QLD 4072, Australia.
J Clin Med. 2023 Mar 31;12(7):2629. doi: 10.3390/jcm12072629.
The temporal trends in haematological parameters and their associations with blood product transfusion requirements in patients supported with extracorporeal membrane oxygenation (ECMO) are poorly understood. We performed a retrospective data analysis to better understand the behaviour of haematological and coagulation parameters and their associations with transfusion requirements during ECMO.
Patient demographics, haematological and coagulation parameters, plasma haemoglobin and fibrinogen concentrations, platelet count, the international normalised ratio (INR), the activated partial thromboplastin time (APTT), and blood product transfusion data from 138 patients who received ECMO in a single high-volume centre were analysed.
Ninety-two patients received venoarterial (VA) ECMO and 46 patients received venovenous (VV) ECMO. The median (IQR) duration of VA, and VV ECMO was 8 (5-13) days and 13 (8-23) days, respectively. There were significant reductions in haemoglobin, the platelet count, and the fibrinogen concentration upon initiation of ECMO. On average, over time, patients on VV ECMO had platelet counts 44 × 10/L higher than those on VA ECMO ( ≤ 0.001). Fibrinogen and APTT did not vary significantly based on the mode of ECMO ( = 0.55 and = 0.072, respectively). A platelet count < 50 × 10/L or a fibrinogen level < 1.8 g/L was associated with 50% chance of PRBC transfusion, regardless of the ECMO type, and packed red blood cell (PRBC) transfusion was more common with VA ECMO. APTT was predictive of the transfusion requirement, and the decrement in APTT was discriminatory between VVECMO survivors and nonsurvivors.
ECMO support is associated with reductions in haemoglobin, platelet count, and fibrinogen. Patients supported with VA ECMO are more likely to receive a PRBC transfusion compared to those on VV ECMO. Thrombocytopaenia, hypofibrinogenaemia, and anticoagulation effect the likelihood of requiring PRBC transfusion. Further research is needed to define optimal blood management during ECMO, including appropriate transfusion triggers and the anticoagulation intensity.
体外膜肺氧合（ECMO）支持患者血液学参数的时间趋势及其与血液制品输注需求的关联尚不清楚。我们进行了一项回顾性数据分析，以更好地了解ECMO期间血液学和凝血参数的变化及其与输血需求的关联。
分析了来自单一高容量中心接受ECMO治疗的138例患者的人口统计学资料、血液学和凝血参数、血浆血红蛋白和纤维蛋白原浓度、血小板计数、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）以及血液制品输注数据。
92例患者接受静脉 - 动脉（VA）ECMO，46例患者接受静脉 - 静脉（VV）ECMO。VA和VV ECMO的中位（IQR）持续时间分别为8（5 - 13）天和13（8 - 23）天。开始ECMO治疗后，血红蛋白、血小板计数和纤维蛋白原浓度显著降低。随着时间推移，平均而言，接受VV ECMO的患者血小板计数比接受VA ECMO的患者高44×10/L（P≤0.001）。纤维蛋白原和APTT根据ECMO模式的不同无显著差异（分别为P = 0.55和P = 0.072）。无论ECMO类型如何，血小板计数<50×10/L或纤维蛋白原水平<1.8 g/L与50%的红细胞输注概率相关，且VA ECMO时红细胞输注更为常见。APTT可预测输血需求，且APTT的降低可区分VV ECMO存活者和非存活者。
ECMO支持与血红蛋白、血小板计数和纤维蛋白原降低有关。与接受VV ECMO的患者相比，接受VA ECMO支持的患者更有可能接受红细胞输注。血小板减少、纤维蛋白原减少和抗凝作用影响红细胞输注的可能性。需要进一步研究来确定ECMO期间的最佳血液管理，包括适当的输血触发因素和抗凝强度。
