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

Maite M.T. van Haeren, MD; Senta Jorinde Raasveld, MD; Mina Karami, MD, PhD; Dinis Dos Reis Miranda, MD, PhD; Loes Mandigers, MD; Dieter F. Dauwe, MD, PhD; Erwin De Troy, MD; Federico Pappalardo, MD, PhD; Evgeny Fominskiy, MD, PhD; Walter M. van den Bergh, MD, PhD; Annemieke Oude Lansink-Hartgring, MD, PhD; Franciska van der Velde, MD; Jacinta J. Maas, MD, PhD; Pablo van de Berg, MD, PhD; Maarten de Haan, ECCP; Dirk W. Donker, MD, PhD; Christiaan L. Meuwese, MD, PhD; Fabio Silvio Taccone, MD, PhD; Lorenzo Peluso, MD; Roberto Lorusso, MD, PhD; Thijs S.R. Delnoij, MD; Erik Scholten, MD; Martijn Overmars, MD; Višnja Ivancan, MD, PhD; Robert Bojčić, MD; Jesse de Metz, MD, PhD; Bas van den Bogaard, MD, PhD; Martin de Bakker, MB, BCh, BAO; Benjamin Reddi, MBChB, PhD; Greet Hermans, MD, PhD; Lars Mikael Broman, MD, PhD; José P.S. Henriques, MD, PhD; Jimmy Schenk, PhD; Alexander P.J. Vlaar, MD, PhD; Marcella C.A. Müller, MD, PhD

doi:10.1097/CCE.0000000000000949

Critical Care Explorations (Aug 2023)

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

Maite M.T. van Haeren, MD,
Senta Jorinde Raasveld, MD,
Mina Karami, MD, PhD,
Dinis Dos Reis Miranda, MD, PhD,
Loes Mandigers, MD,
Dieter F. Dauwe, MD, PhD,
Erwin De Troy, MD,
Federico Pappalardo, MD, PhD,
Evgeny Fominskiy, MD, PhD,
Walter M. van den Bergh, MD, PhD,
Annemieke Oude Lansink-Hartgring, MD, PhD,
Franciska van der Velde, MD,
Jacinta J. Maas, MD, PhD,
Pablo van de Berg, MD, PhD,
Maarten de Haan, ECCP,
Dirk W. Donker, MD, PhD,
Christiaan L. Meuwese, MD, PhD,
Fabio Silvio Taccone, MD, PhD,
Lorenzo Peluso, MD,
Roberto Lorusso, MD, PhD,
Thijs S.R. Delnoij, MD,
Erik Scholten, MD,
Martijn Overmars, MD,
Višnja Ivancan, MD, PhD,
Robert Bojčić, MD,
Jesse de Metz, MD, PhD,
Bas van den Bogaard, MD, PhD,
Martin de Bakker, MB, BCh, BAO,
Benjamin Reddi, MBChB, PhD,
Greet Hermans, MD, PhD,
Lars Mikael Broman, MD, PhD,
José P.S. Henriques, MD, PhD,
Jimmy Schenk, PhD,
Alexander P.J. Vlaar, MD, PhD,
Marcella C.A. Müller, MD, PhD

Affiliations

Maite M.T. van Haeren, MD: 1 Department of Critical Care, Amsterdam University Medical Centers, location Academic Medical Centers, Amsterdam, the Netherlands.
Senta Jorinde Raasveld, MD: 1 Department of Critical Care, Amsterdam University Medical Centers, location Academic Medical Centers, Amsterdam, the Netherlands.
Mina Karami, MD, PhD: 2 Department of Cardiology, Amsterdam University Medical Centers, location Academic Medical Centers, Amsterdam, the Netherlands.
Dinis Dos Reis Miranda, MD, PhD: 3 Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, the Netherlands.
Loes Mandigers, MD: 3 Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, the Netherlands.
Dieter F. Dauwe, MD, PhD: 5 Department of Intensive Care Medicine, Surgical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
Erwin De Troy, MD: 5 Department of Intensive Care Medicine, Surgical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
Federico Pappalardo, MD, PhD: 6 Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Allesandria, Italy.
Evgeny Fominskiy, MD, PhD: 7 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Walter M. van den Bergh, MD, PhD: 8 Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Annemieke Oude Lansink-Hartgring, MD, PhD: 8 Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Franciska van der Velde, MD: 9 Adult Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands.
Jacinta J. Maas, MD, PhD: 9 Adult Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands.
Pablo van de Berg, MD, PhD: 10 Adult Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
Maarten de Haan, ECCP: 11 Department of Extracorporeal Circulation, Catharina hospital Eindhoven, the Netherlands.
Dirk W. Donker, MD, PhD: 12 Intensive Care Center, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands.
Christiaan L. Meuwese, MD, PhD: 3 Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, the Netherlands.
Fabio Silvio Taccone, MD, PhD: 14 Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium.
Lorenzo Peluso, MD: 14 Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium.
Roberto Lorusso, MD, PhD: 15 Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands.
Thijs S.R. Delnoij, MD: 16 Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands.
Erik Scholten, MD: 18 Department of Intensive Care, St. Antonius Hospital, Nieuwegein, the Netherlands.
Martijn Overmars, MD: 18 Department of Intensive Care, St. Antonius Hospital, Nieuwegein, the Netherlands.
Višnja Ivancan, MD, PhD: 19 Department of Anesthesia and Intensive care, University Hospital Centre Zagreb, Zagreb, Croatia.
Robert Bojčić, MD: 19 Department of Anesthesia and Intensive care, University Hospital Centre Zagreb, Zagreb, Croatia.
Jesse de Metz, MD, PhD: 20 Department of Intensive Care, OLVG, Amsterdam, the Netherlands.
Bas van den Bogaard, MD, PhD: 20 Department of Intensive Care, OLVG, Amsterdam, the Netherlands.
Martin de Bakker, MB, BCh, BAO: 21 Department of Critical Care, Royal Adelaide Hospital, Adelaide, Australia.
Benjamin Reddi, MBChB, PhD: 21 Department of Critical Care, Royal Adelaide Hospital, Adelaide, Australia.
Greet Hermans, MD, PhD: 22 Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
Lars Mikael Broman, MD, PhD: 24 Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
José P.S. Henriques, MD, PhD: 2 Department of Cardiology, Amsterdam University Medical Centers, location Academic Medical Centers, Amsterdam, the Netherlands.
Jimmy Schenk, PhD: 1 Department of Critical Care, Amsterdam University Medical Centers, location Academic Medical Centers, Amsterdam, the Netherlands.
Alexander P.J. Vlaar, MD, PhD: 1 Department of Critical Care, Amsterdam University Medical Centers, location Academic Medical Centers, Amsterdam, the Netherlands.
Marcella C.A. Müller, MD, PhD: 1 Department of Critical Care, Amsterdam University Medical Centers, location Academic Medical Centers, Amsterdam, the Netherlands.

DOI: https://doi.org/10.1097/CCE.0000000000000949
Journal volume & issue: Vol. 5, no. 8
p. e0949

Abstract

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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.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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