• Suelyn Van Den Helm, Hui Ping Yaw, Natasha Letunica, Rebecca Barton, Asami Weaver, Fiona Newall, Stephen B Horton, Roberto Chiletti, Amy Johansen, Derek Best, Joanne McKittrick, Warwick Butt, Yves d'Udekem, Graeme MacLaren, Matthew D Linden, Vera Ignjatovic, and Paul Monagle.
• Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
• Crit. Care Med. 2022 Aug 1; 50 (8): 123612451236-1245.

ObjectivesTo investigate platelet pathophysiology associated with pediatric extracorporeal membrane oxygenation (ECMO).DesignProspective observational study of neonatal and pediatric ECMO patients from September 1, 2016, to December 31, 2019.SettingThe PICU in a large tertiary referral pediatric ECMO center.PatientsEighty-seven neonates and children (< 18 yr) supported by ECMO.InterventionsNone.Measurements And Main ResultsArterial blood samples were collected on days 1, 2, and 5 of ECMO and were analyzed by whole blood flow cytometry. Corresponding clinical data for each patient was also recorded. A total of 87 patients were recruited (median age, 65 d; interquartile range [IQR], 7 d to 4 yr). The median duration of ECMO was 5 days (IQR, 3-8 d) with a median length of stay in PICU and hospital of 18 days (IQR, 10-29 d) and 35 days (IQR, 19-75 d), respectively. Forty-two patients (48%) had at least one major bleed according to a priori determined definitions, and 12 patients (14%) had at least one thrombotic event during ECMO. Platelet fibrinogen receptor expression decreased (median fluorescence intensity [MFI], 29,256 vs 26,544; p = 0.0005), while von Willebrand Factor expression increased (MFI: 7,620 vs 8,829; p = 0.0459) from day 2 to day 5 of ECMO. Platelet response to agonist, Thrombin Receptor Activator Peptide 6, also decreased from day 2 to day 5 of ECMO, as measured by binding with anti-P-selectin, PAC-1 (binds activated GPIIb/IIIa), and anti-CD63 monoclonal antibodies (P-selectin area under the curve [AUC]: 63.46 vs 42.82, respectively, p = 0.0022; PAC-1 AUC: 93.75 vs 74.46, p = 0.0191; CD63 AUC: 55.69 vs 41.76, p = 0.0020).ConclusionsThe loss of platelet response over time may contribute to bleeding during ECMO. These novel insights may be useful in understanding mechanisms of bleeding in pediatric ECMO and monitoring platelet markers clinically could allow for prediction or early detection of bleeding and thrombosis.Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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