The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study. (2024)

Affiliation

• Raasveld SJ; Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
• van den Oord C; Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
• Schenk J; Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
• van den Bergh WM; Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam Public Health, University of Amsterdam, Location AMC, Amsterdam, The Netherlands.
• Oude Lansink-Hartgring A; Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
• van der Velde F; Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
• Maas JJ; Adult Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands.
• van de Berg P; Adult Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands.
• Lorusso R; Adult Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
• Delnoij TSR; Cardiothoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
• Dos Reis Miranda D; Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
• Scholten E; Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands.
• Taccone FS; Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, The Netherlands.
• Dauwe DF; Department of Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands.
• De Troy E; Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium.
• Hermans G; Surgical Intensive Care Unit, Department of Intensive Care Medicine, University Hospital Leuven, Leuven, Belgium.
• Pappalardo F; Surgical Intensive Care Unit, Department of Intensive Care Medicine, University Hospital Leuven, Leuven, Belgium.
• Fominskiy E; Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
• Ivancan V; Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
• Bojcic R; Department of CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
• de Metz J; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• van den Bogaard B; Department of Anesthesia and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
• Donker DW; Department of Anesthesia and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
• Meuwese CL; Department of Intensive Care, OLVG, Amsterdam, The Netherlands.
• De Bakker M; Department of Intensive Care, OLVG, Amsterdam, The Netherlands.
• Reddi B; Intensive Care Center, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
• Henriques JPS; Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands.
• Broman LM; Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, The Netherlands.
• Dongelmans DA; Intensive Care Center, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
• Vlaar APJ; Department of Critical Care, Royal Adelaide Hospital, Adelaide, Australia.

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.

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10441744
• https://dx.doi.org/10.1186/s13054-023-04612-5