Journal article
Platelet transfusion stated practices among neonatal and paediatric veno-arterial extracorporeal membrane oxygenation providers: A survey
Vox sanguinis, Vol.120(6), pp.597-604
06/2025
DOI: 10.1111/vox.70018
PMID: 40097240
Abstract
Extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support to over 4000 neonates and children annually worldwide. Although potentially lifesaving, ECMO carries bleeding and thromboembolic risks, often managed with platelet transfusions to maintain specific thresholds. Platelet transfusions themselves carry many risks. This survey aimed to describe stated prophylactic platelet transfusion practices among paediatric veno-arterial (VA)-ECMO providers and identify factors influencing transfusion decisions.
This is a cross-sectional electronic survey of paediatric ECMO providers from 10 centres evaluating platelet transfusion thresholds based on six patient scenarios (non-bleeding, minimally bleeding and resolved bleeding in neonates and children). Descriptive statistics were used for analysis.
The survey response rate was 56% (114 of 204). Paediatric intensivists comprised 66% of respondents. The median pre-transfusion platelet count varied across VA-ECMO scenarios, with a threshold of 50 × 10
/L (interquartile range [IQR] 45-75) for non-bleeding children and 70 × 10
/L (IQR 50-85) for non-bleeding neonates. The threshold for minimally bleeding children, minimally bleeding neonates and resolved bleeding in children was 75 × 10
/L (IQR 50-100). The threshold for resolved bleeding in neonates was 80 × 10
/L (IQR 50-100). There was significant heterogeneity between and within sites (p < 0.001). Uncertainty about the level of evidence was high (59%), with clinical judgement being the most influential factor in transfusion decisions (85%).
Prophylactic platelet transfusion practices in paediatric ECMO vary widely, highlighting uncertainty and the need for clinical trials to improve patient outcomes.
Details
- Title: Subtitle
- Platelet transfusion stated practices among neonatal and paediatric veno-arterial extracorporeal membrane oxygenation providers: A survey
- Creators
- Trupti Ingle - Pediatric Critical Care Medicine, Department of Pediatrics, Yale Medicine, New Haven, Connecticut, USABrian Simms - Yale UniversityJesse Bain - Children's Hospital of Richmond at VCUMelania M Bembea - Johns Hopkins MedicineJill M Cholette - University of RochesterMadhuradhar Chegondi - Children's Hospital of IllinoisEva Cheung - Columbia University Irving Medical CenterRobert Niebler - Children's Hospital of WisconsinCaroline Ozment - Duke UniversityMatthew Paden - Emory UniversityOfer Schiller - Schneider Children's Medical CenterMarianne E Nellis - Cornell UniversityOliver Karam - Yale University
- Resource Type
- Journal article
- Publication Details
- Vox sanguinis, Vol.120(6), pp.597-604
- DOI
- 10.1111/vox.70018
- PMID
- 40097240
- NLM abbreviation
- Vox Sang
- ISSN
- 0042-9007
- eISSN
- 1423-0410
- Publisher
- WILEY
- Language
- English
- Electronic publication date
- 03/17/2025
- Date published
- 06/2025
- Academic Unit
- Stead Family Department of Pediatrics
- Record Identifier
- 9984801614202771
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