Transfusion of blood products to neonatal and pediatric extracorporeal membrane oxygenation patients: A prospective, observational study

STUDY QUESTION: To describe the blood product utilization during neonatal and pediatric extracorporeal membrane oxygenation (ECMO) and to determine whether its usage correlates with clinical outcomes of bleeding, thrombosis or mortality. DESIGN: Prospective observational study of neonatal and pediatric ECMO patients from September 2016, until January 2022. SETTING: Tertiary center for pediatric and neonatal ECMO. PATIENTS: One hundred and ten runs of ECMO, nine patients had two runs of ECMO during the same hospital admission. RESULTS: All patients received at least one red blood cell (RBC) transfusion. RBCs, as well as fresh frozen plasma (FFP), platelets and cryoprecipitate transfusion, as well as total donor exposure did not predict increased mortality in ECMO patients. Increased volume of platelets was associated with patients who bled, but not those who had a thrombosis or died. DISCUSSION: This prospective cohort study failed to demonstrate that the volume of red blood cells, FFP and platelets or total donor exposure was predictive of increased mortality. Of particular importance is the lack of increased volume of red blood cells transfused to patients who experienced major bleeding events compared to those who did not, suggesting that the trigger for transfusions may not be based on the clinical status of bleeding and resultant Hb in isolation.