Santiago MJ, Gómez C, Magaña I, Muñoz V, Saiz P, Sánchez A, López-Herce J.
Hematological complications in children subjected to extracorporeal membrane oxygenation.
Med Intensiva 2018;
43:281-289. [PMID:
29605581 DOI:
10.1016/j.medin.2018.02.003]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/27/2018] [Accepted: 02/01/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVES
To analyze the hematological complications and need for transfusions in children receiving extracorporeal life support (ECLS).
DESIGN
A retrospective study was carried out.
SETTING
A pediatric intensive care unit.
PATIENTS
Children under 18 years of age subjected to ECLS between September 2006 and November 2015.
INTERVENTIONS
None.
VARIABLES OF INTEREST
Patient and ECLS characteristics, anticoagulation, hematological and coagulation parameters, transfusions and clinical course.
RESULTS
A total of 100 patients (94 with heart disease) with a median age of 11 months were studied. Seventy-six patients presented bleeding. The most frequent bleeding point was the mediastinum and 39 patients required revision surgery. In the first 3days, 97% of the patients required blood transfusion (34.4ml/kg per day), 94% platelets (21.1ml/kg per day) and 90% plasma (26.6ml/kg per day). Patients who were in the postoperative period, those who were bleeding at the start of ECLS, those requiring revision surgery, those who could not suspend extracorporeal circulation, and those subjected to transthoracic cannulation required a greater volume of transfusions than the rest of the patients. Thromboembolism occurred in 14 patients and hemolysis in 33 patients. Mortality among the children who were bleeding at the start of ECLS (57.6%) was significantly higher than in the rest of the patients (37.5%) (P=.048).
CONCLUSIONS
Children subjected to ECLS present high blood product needs. The main factors related to transfusions were the postoperative period, bleeding at the start of ECLS, revision surgery, transthoracic cannulation, and the impossibility of suspending extracorporeal circulation. Children with bleeding suffered greater mortality than the rest of the patients.
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