Guillaume Guimbretière, Erwan Flecher, Pierre-Emmanuel Noly, Antoine Roisne, Bernard Lelong, Jean-Philippe Verhoye, Amedeo Anselmi
Institution : Service de chirurgie thoracique, cardiaque et vasculaire, CHU de Rennes
Objectives : To describe the transfusion requirements, prognostic and economic impact of blood transfusions in ECMO/ECLS recipients in a single-center practice.
Methods : We reviewed the prospectively collected data of 509 patients receiving ECMO/ECLS therapy at a tertiary referral center during the 2005-2016 period. Follow-up was prospectively conducted by dedicated personnel (average: 80.25 months ±85.13, 100 % complete).
Results : ECLS was employed in 80.1 % of cases; indications were after heart transplant in 10.6%, post-cardiotomy myocardial failure, 23.1% other indications in 65.6 %. ECMO was employed in the remainders (adult respiratory distress syndrome). Mean age was 53.3 years ±14.9; ECLS patients were significantly older (54.6 years±14.1 vs. 48.2 years±16.9 p<0.001). Platelets and TP levels were significantly lower in the ECLS group at implantation (150.9±83.5 vs. 200.9±123.5 G/mm3 for platelets p<0.001) and (46.2±17 vs. 59.6±18.3 G/mm3 for TP p<0.001). ECLS patients had a higher rate of thrombotic/hemorrhagic complications (60.3% vs. 35.4% p<0.001), and received more frequently both fresh frozen plasma (FFP) (60.5% vs. 31.8% p<0.001) and platelet units (PU) (61.7% vs. 34.1% p<0.001) than ECMO patients. There was no difference in the rate of transfusion of packed red blood cell (pRBC) (83.2 % vs. 80.9%, p=0.6). Post-cardiotomy and post-transplantation patients had significantly higher rate of pRBC, FFP and PU transfusions than other ECLS cases (p<0.001 all). Mortality exceeded 80% among patients who received more than 19 pRBC, 5 PA and/or 12 FFP. The total cost of blood products transfusions was 2,428.8±2,314.4 euros and 2,877.5±2,852.1 euros in survivors vs. non-survivors, respectively (p=0.08); cost was higher in ECLS patients than in ECMO patients (2,850.8±2,622.3 euros vs. 1,885.8±2,583.0 euros respectively; p=0.004).
Conclusion : ECLS/ECMO programs are associated with important consumption of blood products. ECLS patients are likely to have a greater transfusion burden than ECMO patients, particularly in post-cardiotomy and post-transplantation instances. Nonetheless, mortality is greater in cases associated with extreme transfusion requirements. Individualized case discussion is required to avoid futile consumption of blood bank resources.