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Critical Care
Published in: Critical Care 1/2023

Open Access 01-12-2023 | ECMO | Research

The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study

Authors: Senta Jorinde Raasveld, Claudia van den Oord, Jimmy Schenk, Walter M. van den Bergh, Annemieke Oude Lansink - Hartgring, Franciska van der Velde, Jacinta J. Maas, Pablo van de Berg, Roberto Lorusso, Thijs S. R. Delnoij, Dinis Dos Reis Miranda, Erik Scholten, Fabio Silvio Taccone, Dieter F. Dauwe, Erwin De Troy, Greet Hermans, Federico Pappalardo, Evgeny Fominskiy, Višnja Ivancan, Robert Bojčić, Jesse de Metz, Bas van den Bogaard, Dirk W. Donker, Christiaan L. Meuwese, Martin De Bakker, Benjamin Reddi, José P. S. Henriques, Lars Mikael Broman, Dave A. Dongelmans, Alexander P. J. Vlaar

Published in: Critical Care | Issue 1/2023

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Abstract

Background

Thrombocytopenia, hemorrhage and platelet transfusion are common in patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). However, current literature is limited to small single-center experiences with high degrees of heterogeneity. Therefore, we aimed to ascertain in a multicenter study the course and occurrence rate of thrombocytopenia, and to assess the association between thrombocytopenia, hemorrhage and platelet transfusion during VA ECMO.

Methods

This was a sub-study of a multicenter (N = 16) study on transfusion practices in patients on VA ECMO, in which a retrospective cohort (Jan-2018–Jul-2019) focusing on platelets was selected. The primary outcome was thrombocytopenia during VA ECMO, defined as mild (100–150·109/L), moderate (50–100·109/L) and severe (< 50·109/L). Secondary outcomes included the occurrence rate of platelet transfusion, and the association between thrombocytopenia, hemorrhage and platelet transfusion, assessed through mixed-effect models.

Results

Of the 419 patients included, median platelet count at admission was 179·109/L. During VA ECMO, almost all (N = 398, 95%) patients developed a thrombocytopenia, of which a significant part severe (N = 179, 45%). One or more platelet transfusions were administered in 226 patients (54%), whereas 207 patients (49%) suffered a hemorrhagic event during VA ECMO. In non-bleeding patients, still one in three patients received a platelet transfusion. The strongest association to receive a platelet transfusion was found in the presence of severe thrombocytopenia (adjusted OR 31.8, 95% CI 17.9–56.5). After including an interaction term of hemorrhage and thrombocytopenia, this even increased up to an OR of 110 (95% CI 34–360).

Conclusions

Thrombocytopenia has a higher occurrence than is currently recognized. Severe thrombocytopenia is strongly associated with platelet transfusion. Future studies should focus on the etiology of severe thrombocytopenia during ECMO, as well as identifying indications and platelet thresholds for transfusion in the absence of bleeding.
Trial registration: This study was registered at the Netherlands Trial Registry at February 26th, 2020 with number NL8413 and can currently be found at https://​trialsearch.​who.​int/​Trial2.​aspx?​TrialID=​NL8413.​
Appendix
Available only for authorised users
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Metadata
Title
The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
Authors
Senta Jorinde Raasveld
Claudia van den Oord
Jimmy Schenk
Walter M. van den Bergh
Annemieke Oude Lansink - Hartgring
Franciska van der Velde
Jacinta J. Maas
Pablo van de Berg
Roberto Lorusso
Thijs S. R. Delnoij
Dinis Dos Reis Miranda
Erik Scholten
Fabio Silvio Taccone
Dieter F. Dauwe
Erwin De Troy
Greet Hermans
Federico Pappalardo
Evgeny Fominskiy
Višnja Ivancan
Robert Bojčić
Jesse de Metz
Bas van den Bogaard
Dirk W. Donker
Christiaan L. Meuwese
Martin De Bakker
Benjamin Reddi
José P. S. Henriques
Lars Mikael Broman
Dave A. Dongelmans
Alexander P. J. Vlaar
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2023
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-023-04612-5

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