Darryl Abrams1, Matthew R Baldwin1, Matthew Champion2, Cara Agerstrand1, Andrew Eisenberger3, Matthew Bacchetta4, Daniel Brodie5. 1. Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY, USA. 2. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. 3. Division of Hematology and Oncology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. 4. Division of Thoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA. 5. Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY, USA. hdb5@cumc.columbia.edu.
Abstract
PURPOSE: The association between extracorporeal membrane oxygenation (ECMO) use and the development of thrombocytopenia is widely presumed yet weakly demonstrated. We hypothesized that longer duration of ECMO support would be independently associated with worsened thrombocytopenia. METHODS: We performed a single-center retrospective cohort study of 100 adults who received ECMO for acute respiratory failure. We used generalized estimating equations to test the association between days on ECMO and daily percentage of platelets compared to the first post-cannulation platelet count. We constructed a multivariable logistic regression model with backwards stepwise elimination to identify clinical predictors of severe thrombocytopenia (≤50,000/μL) while on ECMO. RESULTS: Days on ECMO was not associated with a decrease in platelet count in the unadjusted analysis (β -0.85, 95 % CI -2.05 to 0.36), nor after considering and controlling for days hospitalized prior to ECMO, APACHE II score, platelet transfusions, and potential thrombocytopenia-inducing medications (β -0.83, 95 % CI -1.9 to 0.25). Twenty-two subjects (22 %) developed severe thrombocytopenia. The APACHE II score and platelet count at the time of cannulation predicted the development of severe thrombocytopenia. The odds of developing severe thrombocytopenia increased 35 % for every 5-point increase in APACHE II score (OR 1.35, 95 % CI 0.94-1.94) and increased 35 % for every 25,000/μL platelets below a mean at cannulation of 188,000/μL (OR 1.35, 95 % CI 1.10-1.64). CONCLUSIONS: Duration of ECMO is not associated with the development of thrombocytopenia. The severity of critical illness and platelet count at the time of cannulation predict the development of severe thrombocytopenia while receiving ECMO for respiratory failure. Future studies should validate these findings, especially in cohorts with more venoarterial ECMO patients, and should characterize the association between thrombocytopenia and bleeding events while on ECMO.
PURPOSE: The association between extracorporeal membrane oxygenation (ECMO) use and the development of thrombocytopenia is widely presumed yet weakly demonstrated. We hypothesized that longer duration of ECMO support would be independently associated with worsened thrombocytopenia. METHODS: We performed a single-center retrospective cohort study of 100 adults who received ECMO for acute respiratory failure. We used generalized estimating equations to test the association between days on ECMO and daily percentage of platelets compared to the first post-cannulation platelet count. We constructed a multivariable logistic regression model with backwards stepwise elimination to identify clinical predictors of severe thrombocytopenia (≤50,000/μL) while on ECMO. RESULTS: Days on ECMO was not associated with a decrease in platelet count in the unadjusted analysis (β -0.85, 95 % CI -2.05 to 0.36), nor after considering and controlling for days hospitalized prior to ECMO, APACHE II score, platelet transfusions, and potential thrombocytopenia-inducing medications (β -0.83, 95 % CI -1.9 to 0.25). Twenty-two subjects (22 %) developed severe thrombocytopenia. The APACHE II score and platelet count at the time of cannulation predicted the development of severe thrombocytopenia. The odds of developing severe thrombocytopenia increased 35 % for every 5-point increase in APACHE II score (OR 1.35, 95 % CI 0.94-1.94) and increased 35 % for every 25,000/μL platelets below a mean at cannulation of 188,000/μL (OR 1.35, 95 % CI 1.10-1.64). CONCLUSIONS: Duration of ECMO is not associated with the development of thrombocytopenia. The severity of critical illness and platelet count at the time of cannulation predict the development of severe thrombocytopenia while receiving ECMO for respiratory failure. Future studies should validate these findings, especially in cohorts with more venoarterial ECMO patients, and should characterize the association between thrombocytopenia and bleeding events while on ECMO.
Authors: Mark A Crowther; Deborah J Cook; Maureen O Meade; Lauren E Griffith; Gordon H Guyatt; Donald M Arnold; Christian G Rabbat; William H Geerts; Theodore E Warkentin Journal: J Crit Care Date: 2005-12 Impact factor: 3.425
Authors: A H Morris; C J Wallace; R L Menlove; T P Clemmer; J F Orme; L K Weaver; N C Dean; F Thomas; T D East; N L Pace; M R Suchyta; E Beck; M Bombino; D F Sittig; S Böhm; B Hoffmann; H Becks; S Butler; J Pearl; B Rasmusson Journal: Am J Respir Crit Care Med Date: 1994-02 Impact factor: 21.405
Authors: Andrew Davies; Daryl Jones; Michael Bailey; John Beca; Rinaldo Bellomo; Nikki Blackwell; Paul Forrest; David Gattas; Emily Granger; Robert Herkes; Andrew Jackson; Shay McGuinness; Priya Nair; Vincent Pellegrino; Ville Pettilä; Brian Plunkett; Roger Pye; Paul Torzillo; Steve Webb; Michael Wilson; Marc Ziegenfuss Journal: JAMA Date: 2009-10-12 Impact factor: 56.272
Authors: Matthieu Schmidt; Peter Schellongowski; Nicolò Patroniti; Fabio Silvio Taccone; Dinis Reis Miranda; Jean Reuter; Helène Prodanovic; Marc Pierrot; Amandine Dorget; Sunghoon Park; Martin Balik; Alexandre Demoule; Ilaria Alice Crippa; Alain Mercat; Philipp Wohlfarth; Romain Sonneville; Alain Combes Journal: Am J Respir Crit Care Med Date: 2018-05-15 Impact factor: 21.405
Authors: Julien Guihaire; Francois Haddad; Mita Hoppenfeld; Myriam Amsallem; Jeffrey W Christle; Clark Owyang; Khizer Shaikh; Joe L Hsu Journal: Can J Cardiol Date: 2019-11-09 Impact factor: 5.223
Authors: Jennifer S McLeod; Joseph T Church; Megan A Coughlin; Benjamin Carr; Clinton Poling; Ellery Sarosi; Elena M Perkins; Matias Caceres Quinones; Pavel Hala; Raja Rabah; Elizabeth Freiheit; Alvaro Rojas-Pena; Robert H Bartlett; George B Mychaliska Journal: J Pediatr Surg Date: 2019-03-01 Impact factor: 2.545