engleski

Coagulation Parameters and Need for Transfusion in Patients with Veno-Arterial Extracorporeal Membrane Oxygenation in Clinical Hospital Center Rijeka

OBJECTIVES: Adult patients supported by veno- arterial extracorporeal membrane oxygenation (V-A ECMO) have high blood products requirements. The main indication are severe cardiac failure and cardiopulmonary resuscitation. Aim: Analysis of coagulation parameters and need for transfusion in ECMO patients during three years period. METHODS: Retrospective analysis and statistics elaboration of medical and laboratory data regarding adult patients during V-A ECMO treatment. RESULTS: In our hospital 38 adult patients were treated by V-A ECMO from 2014 to 2016 ; 9 women and 29 men. Mean ECMO time was 6 days (1 to 19). Surviving patients were 22 and 16 died. The mean values of coagulation parameters on first day were: prothrombin time (PT) 68%, International Normalized Ratio (INR) 1.36, activated partial thromboplastin time (aPTT) 76s, fibrinogen 3.4 g/L, antithrombin III (ATIII) 63%.The highest transfusion requirements patients had during the first day. Red blood cells (RBCs) were transfused to 36 patients (mean number of units in died were 11 vs. 6 in survivors). Eighteen patients received 185 units of fresh frozen plasma (FFP), mean number of units in died were 8 vs. 6 in survivors. The same number of patients received transfusion of 122 units of platelets (mean number of units in died were 4 vs. 3 in survivors). Antithrombin III was the most frequently used blood derivate during the first ECMO day in 9 patients (mean units in died were 469 vs. 227 in survivors). During monitoring of coagulation parameters normalization of all values is obvious, except of ATIII which was under lower limits all the time. CONCLUSIONS: The values of PT/INR, aPTT and antithrombin III are the most subjected to the changes during the initial period of ECMO treatment. Transfusion requirements of blood components and derivates were the mostly intense on the first day. The difference between patients who died and survivors was clinically significant although statistically can not be determined due to small sample.

V-A ECMO, Coagulation, Transfusion

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