The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
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
Affiliations
Senta Jorinde Raasveld
Department of Critical Care, Amsterdam University Medical Centers
Claudia van den Oord
Department of Critical Care, Amsterdam University Medical Centers
Jimmy Schenk
Department of Critical Care, Amsterdam University Medical Centers
Walter M. van den Bergh
Department of Critical Care, University Medical Center Groningen, University of Groningen
Annemieke Oude Lansink - Hartgring
Department of Critical Care, University Medical Center Groningen, University of Groningen
Franciska van der Velde
Adult Intensive Care Unit, Leiden University Medical Center
Jacinta J. Maas
Adult Intensive Care Unit, Leiden University Medical Center
Pablo van de Berg
Adult Intensive Care Unit, Catharina Hospital Eindhoven
Roberto Lorusso
Cardiothoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht (CARIM)
Thijs S. R. Delnoij
Department of Cardiology, Maastricht University Medical Center
Dinis Dos Reis Miranda
Adult Intensive Care Unit, Erasmus University Medical Center
Erik Scholten
Department of Intensive Care, St. Antonius Hospital
Fabio Silvio Taccone
Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles
Dieter F. Dauwe
Surgical Intensive Care Unit, Department of Intensive Care Medicine, University Hospital Leuven
Erwin De Troy
Surgical Intensive Care Unit, Department of Intensive Care Medicine, University Hospital Leuven
Greet Hermans
Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven
Federico Pappalardo
Department of CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo
Evgeny Fominskiy
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
Višnja Ivancan
Department of Anesthesia and Intensive Care, University Hospital Centre Zagreb
Robert Bojčić
Department of Anesthesia and Intensive Care, University Hospital Centre Zagreb
Jesse de Metz
Department of Intensive Care, OLVG
Bas van den Bogaard
Department of Intensive Care, OLVG
Dirk W. Donker
Intensive Care Center, University Medical Center Utrecht (UMCU)
Christiaan L. Meuwese
Adult Intensive Care Unit, Erasmus University Medical Center
Martin De Bakker
Department of Critical Care, Royal Adelaide Hospital
Benjamin Reddi
Department of Critical Care, Royal Adelaide Hospital
José P. S. Henriques
Department of Cardiology, Amsterdam University Medical Centers
Lars Mikael Broman
ECMO Center Karolinska, Karolinska University Hospital
Dave A. Dongelmans
Department of Critical Care, Amsterdam University Medical Centers
Alexander P. J. Vlaar
Department of Critical Care, Amsterdam University Medical Centers
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.
