The Use of Antifactor Xa Assays in a Comprehensive Pediatric Extracorporeal Membrane Oxygenation Anticoagulation Protocol is Associated with Increased Survival and Significant Blood Product Cost-Savings

2021 ◽  
Author(s):  
Shawn B. Sood ◽  
Louisa Anne Walker ◽  
Rangaraj Ramanujam ◽  
Daphne Hardison ◽  
Jennifer Andrews ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Blood Product ◽  
Cost Savings ◽  
Blood Component ◽  
Transfusion Threshold ◽  
Total Blood ◽  
Product Cost ◽  
Membrane Oxygenation ◽  
Antifactor Xa ◽  
Laboratory Protocol

AbstractWe augmented our standard extracorporeal membrane oxygenation laboratory protocol to include antifactor Xa assays, thromboelastography, and antithrombin measurements. We performed a retrospective chart review to determine outcomes for patients placed on extracorporeal membrane oxygenation (ECMO) prior to and after the initiation of our anticoagulation laboratory protocol. A total of 663 consecutive ECMO runs were evaluated from January 1, 2007 to June 30, 2018. Of these patients, 252 were on ECMO prior to initiation of the anticoagulation laboratory protocol on September 1, 2011, and 411 patients were on ECMO after initiation of the protocol. There were no major changes to our extracorporeal membrane oxygenation circuit or changes to our transfusion threshold during this continuous study period. Transfusion utilization data revealed statistically significant decreases in almost all blood components, and a savings in blood component inflation-adjusted acquisition costs of 31% bringing total blood product cost-savings to $309,905 per year. In addition, there was an increase in survival to hospital discharge from 45 to 56% associated with the initiation of the protocol (p = 0.004). Our data indicate that implementation of a standardized ECMO anticoagulation protocol, which titrates unfractionated heparin infusions based on antifactor Xa assays, is associated with reduced blood product utilization, significant blood product cost savings, and increased patient survival. Future prospective evaluation is needed to establish an antifactor Xa assay-driven ECMO anticoagulation strategy as both clinically superior and cost-effective.

Venous Thromboembolism and Transfusion Medicine

2018 ◽  
Author(s):  
Maulik Rajyaguru ◽  
Jill Yaung
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Clinical Judgment ◽  
Blood Product ◽  
Blood Component ◽  
Transfusion Medicine ◽  
Transfusion Threshold ◽  
Mechanical Prophylaxis ◽  
Key Words Anticoagulation ◽  
Review Current

Venous thromboembolism (VTE) and transfusion medicine are frequently encountered issues in the intensive care unit. VTE can significantly worsen the risk of morbidity and mortality in any hospitalized patient, but proper preventive measures can reduce its incidence. Blood product transfusions can be lifesaving in appropriate situations but can also be both medically and economically detrimental if used without proper clinical judgment. In this review, we present an overview of VTE diagnosis, pharmacologic and mechanical prophylaxis, and treatment. Additionally, we review current indications for blood product use in various clinical situations, basics of massive transfusions, and adverse medical reactions to transfusions. This review contains 2 figures, 6 tables, and 50 references. Key Words: anticoagulation, blood component separation, venous thrombosis, immunohematology, massive transfusion, superficial venous thrombosis, transfusion threshold, venous thromboembolism

BLOOD COMPONENT UTILIZATION AND COSTING OF PAEDIATRIC EXTRACORPOREAL MEMBRANE OXYGENATION.

2006 ◽  
Vol 34 ◽  
pp. A73
Author(s):  
Navjeet Uppal ◽  
Wendy Lau ◽  
David Edgell ◽  
Christopher S Parshuram
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Blood Component ◽  
Membrane Oxygenation

scholarly journals Context-Responsive Anticoagulation Reduces Complications in Pediatric Extracorporeal Membrane Oxygenation

2021 ◽  
Vol 8 ◽  
Author(s):  
John C. Lin ◽  
Lauren M. Barron ◽  
Adam M. Vogel ◽  
Ryan M. Colvin ◽  
Sirine A. Baltagi ◽  
...  
Keyword(s):  
Data Collection ◽  
Extracorporeal Membrane Oxygenation ◽  
Blood Product ◽  
Complication Rates ◽  
Membrane Oxygenation ◽  
Hemorrhagic Complications ◽  
Implementation Period ◽  
Thrombotic Complications ◽  
The Impact ◽  
Rbc Transfusion

Purpose: We sought to determine the impact of a comprehensive, context-responsive anticoagulation and transfusion guideline on bleeding and thrombotic complication rates and blood product utilization during extracorporeal membrane oxygenation (ECMO).Design: Single-center, observational pre- and post-implementation cohort study.Setting: Academic pediatric hospital.Patients: Patients in the PICU, CICU, and NICU receiving ECMO support.Interventions: Program-wide implementation of a context-responsive anticoagulation and transfusion guideline.Measurements: Pre-implementation subjects consisted of all patients receiving ECMO between January 1 and December 31, 2012, and underwent retrospective chart review. Post-implementation subjects consisted of all ECMO patients between September 1, 2013, and December 31, 2014, and underwent prospective data collection. Data collection included standard demographic and admission data, ECMO technical specifications, non-ECMO therapies, coagulation parameters, and blood product administration. A novel grading scale was used to define hemorrhagic complications (major, intermediate, and minor) and major thromboembolic complications.Main Results: Seventy-six ECMO patients were identified: 31 during the pre-implementation period and 45 in the post-implementation period. The overall observed mortality was 33% with no difference between groups. Compared to pre-implementation, the post-implementation group experienced fewer major hemorrhagic and major thrombotic complications and less severe hemorrhagic complications and received less RBC transfusion volume per kg.Conclusions: Use of a context-responsive anticoagulation and transfusion guideline was associated with a reduction in hemorrhagic and thrombotic complications and reduced RBC transfusion requirements. Further evaluation of guideline content, compliance, performance, and sustainability is needed.

A Program to Limit Donor Exposures to Neonates Undergoing Extracorporeal Membrane Oxygenation

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 341-346 ◽  
Author(s):  
Ellen M. Rosenberg ◽  
Linda A. Chambers ◽  
Jean M. Gunter ◽  
Joseph A. Good
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Blood Donor ◽  
Retrospective Chart Review ◽  
Transfusion Practice ◽  
Blood Component ◽  
Excessive Bleeding ◽  
Packed Red Blood Cells ◽  
Membrane Oxygenation ◽  
Single Donor ◽  
Related Donor

Objective. Extracorporeal membrane oxygenation (ECMO) has dramatically improved the survival of neonates with life-threatening respiratory and cardiac failure. However, ECMO requires numerous transfusions with significant risks. This study evaluated the effects of changing transfusion practices and blood component management on blood donor exposures in neonatal ECMO. Design. A 3-year retrospective chart review of all neonatal ECMO patients from December 1989 through November 1992 was undertaken. During this 3-year period, transfusion practices and blood product preparation were altered twice to reduce blood donor exposures. The use of apheresis platelets and fresh frozen plasma (FFP), and preserving the expiration date on packed red blood cells (PRBCs) through the use of a sterile connecting device, allowed multiple transfusions from individual donor components. In addition, education of the ECMO physicians was focused on standardizing and reducing transfused volumes. Sixty-four surviving neonatal patients (91.4%) were evaluated. Five patients had excessive bleeding and were excluded from analysis. The remaining 59 patients were divided into three protocols based upon the transfusion practice at the time of their ECMO course. Protocol 1 received PRBCs less than 5 days of age, volume-reduced platelet concentrates, and standard FFP units up to 24 hours after thawing. Changes in transfusion practice for protocol 2 included extended outdate for PRBCs to 10 days, and using single donor apheresis platelet aliquots. The third protocol entailed the use single donor apheresis FRP aliquots in addition to the protocol 2 changes. Results. Total PRBC transfusion volumes (721 ± 406 ml for protocol 1, 637 ± 172 ml for protocol 3) and associated blood donor exposures (5 ± 2.1 for protocol 1, 3.9 ± 0.9 for protocol 3) did not change substantially over the reviewed period. However, FFP transfusion volumes (478 ± 170 ml for protocol 1, 274 ± 63 ml for protocol 3), FFP-related donor exposures (4.5 ± 1.6 for protocol 1, 1.2 ± 0.4 for protocol 3) and platelet-related donor exposures (4.6 ± 3.6 for protocol 1, 2.5 ± 1.5 for protocol 3) were reduced progressively and significantly from protocol 1 to protocol 3 (P < .01, Tukey's B test adjusted for multiple comparisons). The total number of donor exposures per patient while on ECMO was decreased from 14.1 in protocol 1 to 10.0 in protocol 2 to 7.5 in protocol 3 (P < .01). Conclusions. We conclude that the changes in blood bank component selection and management as well as physician practice were effective in substantially reducing ECMO-related transfusion volumes and the resulting donor exposures.

Blood Component Usage during Extracorporeal Membrane Oxygenation: Experience in 98 Patients at a Latin-American Tertiary Hospital

2014 ◽  
Vol 37 (3) ◽  
pp. 233-240 ◽  
Author(s):  
Marcela Henríquez-Henríquez ◽  
Javier Kattan ◽  
Mayling Chang ◽  
Isabel Pizarro ◽  
Miriam Faunes ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Latin American ◽  
Tertiary Hospital ◽  
Blood Component ◽  
Membrane Oxygenation

Increased blood transfusion and its impact in patients having tracheostomy while on extracorporeal membrane oxygenation

Perfusion ◽  
2018 ◽  
Vol 34 (2) ◽  
pp. 143-146 ◽  
Author(s):  
Dwight D. Harris ◽  
Alexis E. Shafii ◽  
Maher Baz ◽  
Thomas A. Tribble ◽  
Victor A. Ferraris
Keyword(s):  
Blood Loss ◽  
Extracorporeal Membrane Oxygenation ◽  
Blood Products ◽  
Inclusion Criteria ◽  
Total Blood ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
The Impact ◽  
Complications And Mortality ◽  
Vv Ecmo

Introduction: Tracheostomy has been utilized in combination with venovenous extracorporeal membrane oxygenation (VV-ECMO) to enable early spontaneous breathing and minimize sedation requirements. Tracheostomy has been previously reported to be safe in patients supported on VV-ECMO; however, the impact of tracheostomy on blood loss in VV-ECMO patients is unknown. Methods: We analyzed VV-ECMO patients with and without tracheostomy over a 5-year period. In order to avoid other potential sources of blood loss not related to tracheostomy or ECMO-related blood loss, patients who underwent a recent surgery prior to ECMO or during ECMO (other than tracheostomy) were excluded. Results: Sixty-three patients meeting the inclusion criteria were identified (tracheostomy n=30, non-tracheostomy n=33). Tracheostomy patients were found to require more daily transfusions of red blood cells (RBC) (0.47 [0.20-1.0] vs. 0.23 [0.06-0.40] units/day, p=0.02) and total blood products (0.60 [0.32-1.0] vs. 0.31 [0.10-0.50] units/day, p=0.01). Conclusions: These results suggest that tracheostomy while on VV-ECMO predisposes patients to increased transfusion burden. Based on previous research, this increased transfusion burden could potentially be linked to increased complications and mortality.

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