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THROMBOCYTOPENIA AND MORBIDITY IN PEDIATRIC POST-CARDIOTOMY VENO-ARTERIAL EXTRACORPOREAL MEMBRANE
- Yu Jin (China)
Abstract
Background and Aims
Platelets play an important role in hemostasis. Thrombocytopenia after cardiopulmonary bypass (CPB) is associated with increased morbidity and mortality. This study explores the effects of the maximum single-day platelets drop percent and the duration of platelets drop on complications and outcomes in ECMO failed to wean from CPB.
Methods
We retrospectively analyzed 65 pediatric post-cardiotomy patients (aged <18 years) who directly transitioned from CPB to ECMO, from January 2010 to June 2020. They were divided into survivors (n = 34) and non-survivors (n = 31) according to in-hospital mortality. We compared the incidence of various complications and outcomes between groups. Furthermore, we examined the associations between the maximum single-day platelets drop percent and the duration of platelets drop during ECMO, morbidity and blood product transfusion.
Results
The maximum single-day platelets drop percent had predictive value for hemolysis and circuit change; the duration of platelets drop could predict hemolysis, severe acute kidney injury (AKI) and neurological dysfunction. Moreover, the correlations between them and peak plasma-free hemoglobin, peak serum creatinine, transfusion of red blood cell, platelets and fresh frozen plasma and chest-tube drainage were significant. Multivariate logistic regression analysis identified that the maximum single-day platelets drop percent was positively correlated with hemolysis, and the duration of platelets drop was positively associated with AKI.
Conclusions
The platelets drop contributed to hemolysis and AKI in pediatric post-cardiotomy ECMO failed to wean from CPB. Various complications occurred together with thrombocytopenia during ECMO, leading to poor prognosis. We need more scientific evidence and clinical practice in the future.