ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2020 January;86(1):47-55

DOI: 10.23736/S0375-9393.19.13713-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Predictors of bleeding in ECMO patients undergoing surgery

Florian HOLZER ¹ ✉, Michael GRUBER ¹, Alois PHILIPP ², Dirk LUNZ ¹, Bernhard GRAF ¹, Andreas REDEL ¹

¹ Department of Anesthesiology, University Medical Center, Regensburg, Germany; ² Department of Cardiac Surgery, University Medical Center, Regensburg, Germany

BACKGROUND: Bleeding is a major adverse effect of veno-venous extracorporeal membrane oxygenation (vvECMO) therapy in surgical patients. This study retrospectively describes the amount of transfused packed red blood cells (PRBC) and coagulation parameters of patients requiring surgery during vvECMO therapy.
METHODS: We included patients who underwent at least one surgical procedure during vvECMO therapy and analyzed hemoglobin levels, coagulation parameters, blood gas parameters and transfused blood products. Patients with perioperative transfusion of less than two PRBC during the perioperative period (group A) were compared to those who were given two or more PRBCs (group B).
RESULTS: Seventy-three patients (group A: 42 patients, group B: 31 patients) were included. Activated PTT (54.7 vs. 56.2 sec), Quick test (61.5% vs. 60.0%), Platelet count (91 vs 72 / nL, P=0.322) and mortality (40.5 vs. 45.2%; P=0.689) were not different between both groups. Fibrinogen was significantly decreased in group B (245 mg/dL) compared to group A (353 mg/dL; P=0.004).
CONCLUSIONS: In patients requiring surgery during vvECMO therapy with perioperative transfusion of two or more PRBCs preoperative fibrinogen levels were significantly reduced compared to patients with transfusion of less than two PRBCs. No other analyzed lab value showed any predictive qualities in terms of bleeding.

KEY WORDS: Extracorporeal membrane oxygenation; Hemorrhage; Blood transfusion; Blood coagulation