Massive Transfusion as a Predictor of Survival in Pediatric Patients Receiving Extracorporeal Life Support Open Access

Winkler, Anne Marie (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/dn39x215z?locale=en
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Abstract

Extracorporeal life support (ECLS) is a technique that has been shown to be effective in supporting patients of all ages with life-threatening cardio-respiratory failure of varying etiologies and has become the standard therapy for neonatal, pediatric and adult patients with acute cardiac or respiratory failure that is unresponsive to traditional management. As a result of added extracorporeal volume, acquired hemostatic changes, and occurrence of hematologic complications, transfusion requirements associated with ECLS are very high and patients are commonly massively transfused; however, associations between massive transfusion, complications, and all-cause mortality have not been formally investigated in ECLS patients. One prior study demonstrated a weak association between each packed red blood cell (RBC) transfusion volume of 10 ml/kg/day and in-hospital mortality (OR 1.024, CI 1.004-1.046, p=0.018) in ECLS patients(15). As a result, a cohort study of all ECLS patients less than 18 years of age was conducted at a single institution from 1/1/2009 - 12/31/2011 to examine the association between massive transfusion, defined as RBC transfusion of greater than one blood volume plus circuit volume based upon on patient weight, complications, and all-cause mortality. In this cohort, massive transfusion which occurred in 32.7% of the entire cohort and 36.3% of neonatal subjects was associated with increased all-cause mortality, and this effect was stronger for neonates (OR 6.45, CI 1.81-22.9, p=0.004). Kaplan-Meier estimates for the probability of death did significantly differ between subjects who were massively transfused versus those who were not (Log rank <0.0001) and the effect of massive transfusion was time-dependent. Subjects who were massively transfused with an ECLS duration greater than 4 hours had an increased hazard of death (HR 3.38, CI1.59-7.20, p=0.002) when controlling for ECLS mode. As a result, massive transfusion is independently associated with an increased risk for all-cause mortality, similar to investigations linking RBC transfusion to increased morbidity and mortality in non-ECLS critically ill patients.

Table of Contents

INTRODUCTION…………………………………………………………. 1

BACKGROUND…………………………………………………………… 2

METHODS………………………………………………………………… 6

RESULTS………………………………………………………………….. 10

DISCUSSION……………………………………………………………… 13

REFERENCES…………………………………………………………….. 16

TABLES AND FIGURES………………………………………………… 18

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