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Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices

OBJECTIVES: To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and proth...

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Autores principales: van Haeren, Maite M.T., Raasveld, Senta Jorinde, Karami, Mina, Miranda, Dinis Dos Reis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, van den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, de Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, de Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., Schenk, Jimmy, Vlaar, Alexander P.J., Müller, Marcella C.A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443757/
https://www.ncbi.nlm.nih.gov/pubmed/37614800
http://dx.doi.org/10.1097/CCE.0000000000000949
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author van Haeren, Maite M.T.
Raasveld, Senta Jorinde
Karami, Mina
Miranda, Dinis Dos Reis
Mandigers, Loes
Dauwe, Dieter F.
De Troy, Erwin
Pappalardo, Federico
Fominskiy, Evgeny
van den Bergh, Walter M.
Oude Lansink-Hartgring, Annemieke
van der Velde, Franciska
Maas, Jacinta J.
van de Berg, Pablo
de Haan, Maarten
Donker, Dirk W.
Meuwese, Christiaan L.
Taccone, Fabio Silvio
Peluso, Lorenzo
Lorusso, Roberto
Delnoij, Thijs S.R.
Scholten, Erik
Overmars, Martijn
Ivancan, Višnja
Bojčić, Robert
de Metz, Jesse
van den Bogaard, Bas
de Bakker, Martin
Reddi, Benjamin
Hermans, Greet
Broman, Lars Mikael
Henriques, José P.S.
Schenk, Jimmy
Vlaar, Alexander P.J.
Müller, Marcella C.A.
author_facet van Haeren, Maite M.T.
Raasveld, Senta Jorinde
Karami, Mina
Miranda, Dinis Dos Reis
Mandigers, Loes
Dauwe, Dieter F.
De Troy, Erwin
Pappalardo, Federico
Fominskiy, Evgeny
van den Bergh, Walter M.
Oude Lansink-Hartgring, Annemieke
van der Velde, Franciska
Maas, Jacinta J.
van de Berg, Pablo
de Haan, Maarten
Donker, Dirk W.
Meuwese, Christiaan L.
Taccone, Fabio Silvio
Peluso, Lorenzo
Lorusso, Roberto
Delnoij, Thijs S.R.
Scholten, Erik
Overmars, Martijn
Ivancan, Višnja
Bojčić, Robert
de Metz, Jesse
van den Bogaard, Bas
de Bakker, Martin
Reddi, Benjamin
Hermans, Greet
Broman, Lars Mikael
Henriques, José P.S.
Schenk, Jimmy
Vlaar, Alexander P.J.
Müller, Marcella C.A.
author_sort van Haeren, Maite M.T.
collection PubMed
description OBJECTIVES: To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) in patients on ECMO. DESIGN: A prespecified subanalysis of a multicenter retrospective study. Venovenous (VV)-ECMO and venoarterial (VA)-ECMO are analyzed as separate populations, comparing patients with and without bleeding and with and without thrombotic complications. SETTING: Sixteen international ICUs. PATIENTS: Adult patients on VA-ECMO or VV-ECMO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 420 VA-ECMO patients, 59% (n = 247) received plasma, 20% (n = 82) received fibrinogen concentrate, 17% (n = 70) received TXA, and 7% of patients (n = 28) received PCC. Fifty percent of patients (n = 208) suffered bleeding complications and 27% (n = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, p < 0.001), fibrinogen concentrate (28% vs 11%, p < 0.001), and TXA (23% vs 10%, p < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, p = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% (n = 81) received plasma, 6% (n = 12) fibrinogen concentrate, 7% (n = 14) TXA, and 5% (n = 10) PCC. Thirty-nine percent (n = 80) of VV-ECMO patients suffered bleeding complications and 23% (n = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, p < 0.001), fibrinogen concentrate (13% vs 2%, p < 0.01), and TXA (11% vs 2%, p < 0.01). CONCLUSIONS: The majority of patients on ECMO receive transfusions of plasma, procoagulant products, or antifibrinolytics. In a significant part of the plasma transfused patients, this was in the absence of bleeding or prolonged international normalized ratio. This poses the question if these plasma transfusions were administered for another indication or could have been avoided.
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spelling pubmed-104437572023-08-23 Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices van Haeren, Maite M.T. Raasveld, Senta Jorinde Karami, Mina Miranda, Dinis Dos Reis Mandigers, Loes Dauwe, Dieter F. De Troy, Erwin Pappalardo, Federico Fominskiy, Evgeny van den Bergh, Walter M. Oude Lansink-Hartgring, Annemieke van der Velde, Franciska Maas, Jacinta J. van de Berg, Pablo de Haan, Maarten Donker, Dirk W. Meuwese, Christiaan L. Taccone, Fabio Silvio Peluso, Lorenzo Lorusso, Roberto Delnoij, Thijs S.R. Scholten, Erik Overmars, Martijn Ivancan, Višnja Bojčić, Robert de Metz, Jesse van den Bogaard, Bas de Bakker, Martin Reddi, Benjamin Hermans, Greet Broman, Lars Mikael Henriques, José P.S. Schenk, Jimmy Vlaar, Alexander P.J. Müller, Marcella C.A. Crit Care Explor Observational Study OBJECTIVES: To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) in patients on ECMO. DESIGN: A prespecified subanalysis of a multicenter retrospective study. Venovenous (VV)-ECMO and venoarterial (VA)-ECMO are analyzed as separate populations, comparing patients with and without bleeding and with and without thrombotic complications. SETTING: Sixteen international ICUs. PATIENTS: Adult patients on VA-ECMO or VV-ECMO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 420 VA-ECMO patients, 59% (n = 247) received plasma, 20% (n = 82) received fibrinogen concentrate, 17% (n = 70) received TXA, and 7% of patients (n = 28) received PCC. Fifty percent of patients (n = 208) suffered bleeding complications and 27% (n = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, p < 0.001), fibrinogen concentrate (28% vs 11%, p < 0.001), and TXA (23% vs 10%, p < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, p = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% (n = 81) received plasma, 6% (n = 12) fibrinogen concentrate, 7% (n = 14) TXA, and 5% (n = 10) PCC. Thirty-nine percent (n = 80) of VV-ECMO patients suffered bleeding complications and 23% (n = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, p < 0.001), fibrinogen concentrate (13% vs 2%, p < 0.01), and TXA (11% vs 2%, p < 0.01). CONCLUSIONS: The majority of patients on ECMO receive transfusions of plasma, procoagulant products, or antifibrinolytics. In a significant part of the plasma transfused patients, this was in the absence of bleeding or prolonged international normalized ratio. This poses the question if these plasma transfusions were administered for another indication or could have been avoided. Lippincott Williams & Wilkins 2023-08-21 /pmc/articles/PMC10443757/ /pubmed/37614800 http://dx.doi.org/10.1097/CCE.0000000000000949 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Observational Study
van Haeren, Maite M.T.
Raasveld, Senta Jorinde
Karami, Mina
Miranda, Dinis Dos Reis
Mandigers, Loes
Dauwe, Dieter F.
De Troy, Erwin
Pappalardo, Federico
Fominskiy, Evgeny
van den Bergh, Walter M.
Oude Lansink-Hartgring, Annemieke
van der Velde, Franciska
Maas, Jacinta J.
van de Berg, Pablo
de Haan, Maarten
Donker, Dirk W.
Meuwese, Christiaan L.
Taccone, Fabio Silvio
Peluso, Lorenzo
Lorusso, Roberto
Delnoij, Thijs S.R.
Scholten, Erik
Overmars, Martijn
Ivancan, Višnja
Bojčić, Robert
de Metz, Jesse
van den Bogaard, Bas
de Bakker, Martin
Reddi, Benjamin
Hermans, Greet
Broman, Lars Mikael
Henriques, José P.S.
Schenk, Jimmy
Vlaar, Alexander P.J.
Müller, Marcella C.A.
Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices
title Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices
title_full Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices
title_fullStr Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices
title_full_unstemmed Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices
title_short Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices
title_sort plasma transfusion and procoagulant product administration in extracorporeal membrane oxygenation: a secondary analysis of an international observational study on current practices
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443757/
https://www.ncbi.nlm.nih.gov/pubmed/37614800
http://dx.doi.org/10.1097/CCE.0000000000000949
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