771 - Platelet Transfusion Practices for Children Supported by Extracorporeal Membrane Oxygenation
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 771 Publication Number: 771.306
Marianne Nellis, Weill Cornell Medicine, Cornell University, New York, NY, United States; Jesse Bain, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Melania M. Bembea, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Madhuradhar Chegondi, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States; Eva Cheung, Columbia Irving Medical Center, New York, NY, United States; Jill M. Cholette, University of Rochester, Rochester, NY, United States; Umesh C. Joashi, Weill Cornell Medical Center, New York, NY, United States; Robert A. Niebler, Medical College of Wisconsin, MILWAUKEE, WI, United States; Matthew Paden, Children's Healthcare of Atlanta, Atlanta, GA, United States; Caroline Ozment, Duke University, Durham, NC, United States; Ofer Schiller, Schneider Children's Medical center, Kfar Saba, HaMerkaz, Israel; Oliver Karam, Yale, New Haven, CT, United States
Weill Cornell Medicine, Cornell University New York, New York, United States
Background: While extracorporeal membrane oxygenation (ECMO) may be lifesaving, bleeding is a frequent complication due to endogenous and circuit-induced coagulopathy, thrombocytopenia, and platelet dysfunction in addition to pharmacological induction that disrupts coagulation. Platelet transfusions are commonly prescribed to prevent or treat bleeding, but the practice varies, given the lack of evidence-based guidelines. Objective: To describe stated platelet transfusion practices among pediatric ECMO providers. Design/Methods: Cross-sectional electronic survey administered to pediatric ECMO providers at 10 ECMO centers (9 in the United States and 1 in Israel). The survey included six patient scenarios: non-bleeding child, non-bleeding neonate, minimally bleeding child, minimally bleeding neonate, child with resolved bleeding, and neonate with resolved bleeding. Data analysis included descriptive statistics. Results: The overall response rate was 56% (114/204). Of those providing demographic information, 66% (68/103) were pediatric intensivists and 37% (38/103) were pediatric cardiac intensivists. Regarding overall platelet transfusion thresholds, the median pre-transfusion platelet count was 70 (IQR 50-99) x109/L with differences depending on the scenario. The median platelet threshold was 50 (IQR 45-75) x109/L for non-bleeding children, 70 (IQR 50-85) x109/L for non-bleeding neonates, 75 (IQR 50-100) x109/L for minimally bleeding children, and for minimally bleeding neonates, 75 (IQR 50-100) x109/L for resolved bleeding in children, and 80 (IQR 50-100) x109/L for resolved bleeding in neonates. There was a wide heterogeneity between and within sites (p < 0.001 respectively. Of the responders, 59% (61/103) were uncertain/very uncertain, 33% (34/103) were neutral, and 8% (8/103) were certain/very certain about the level of evidence. The level of certainty was not associated with a specific site (p 0.39 - 0.93). Eighty-five percent (88/103) reported that clinical judgement was the most important factor in deciding to transfuse platelets.
Conclusion(s): Platelet transfusion practices for non or minimally bleeding children on ECMO are varied and based on clinical judgment. Controlled trials are needed to test various platelet transfusion strategies in this vulnerable patient population.
