Platelet Changes during Extracorporeal Membrane Oxygenation in Patients with Different Modes of Support: a Retrospective Cohort Study

Abstract

Background Extracorporeal membrane oxygenation (ECMO) has been widely used in the treatment of various acute and critical heart and respiratory failure diseases. However, platelet (PLT) counts decrease significantly during the treatment, which increases the risk of bleeding and thus affecting the prognosis of patients. Therefore, the explore of changes in PLT counts during ECMO support can help prevent bleeding related risks caused by thrombocytopenia, thus improving the prognosis of patients. Objective To retrospectively analyse the changes of PLT counts during ECMO support under different support modes. Methods 40 adult patients received veno-venous ECMO (V-V ECMO) or veno-arterial ECMO (V-A ECMO) support from January 2019 to October 2021 at the heart center of the People's Hospital of Gaozhou were included as study subjects and divided into the death group (n=22) and survival group (n=18) according to the occurrence of death after ECMO. PLT and platelet infusion were collected at baseline, before ECMO, and during the intervention. Results The average age of patients was (49.0±17.8) years, and the average duration of ECMO support was (6.0±3.2) days. There was statistically significant difference in the proportion of ECMO intervention reasons between the operation group and the non-operation group (P<0.05). The incidence of thrombocytopenia before ECMO support was 18% (7/40), among which three patients were treated with V-V ECMO, all of whom suffering from severe pneumonia, and four patients were treated with V-A ECMO. After 1 day of ECMO support, the incidence of thrombocytopenia was 56.0% (18/32), among which four patients were treated with V-V ECMO, fourteen patients were treated with V-A ECMO. Nine patients in the non-operation group and 13 patients in the operation group received platelet transfusion. The effective rate of initial platelet transfusion was 59.1% (13/22). The proportion of thrombocytopenia before ECMO support in the operation group was higher than that in the non-operation group, with statistically significant difference (P<0.05). The lowest PLT count was observed on day 4 of ECMO in the non-operation group and day 5 of ECMO support in the operation group. The age of patients in the death group was higher than that in the non-death group, and the ECMO support time, weaning rate and PLT count on the day 7 of ECMO support were lower than those in the non-death group, with statistically significant difference (P<0.05) . Conclusion PLT count reached the lowest value on the day 3-4 of ECMO support and correlated with the prognosis of patients. The initial infusion of allogeneic platelets can increase PLT count in patients, suggesting that the corresponding intervention preparations should be made according to the changes of PLT in clinical practice, so as to reduce bleeding and other complications caused by thrombocytopenia and improve the prognosis of patients receiving ECMO support.

Keywords

• heart failure|respiratory insufficiency|thrombocytopenia|extracorporeal membrane oxygenation|prognosis|root cause analysis