• Senta Jorinde Raasveld, Claudia van den Oord, Jimmy Schenk, Walter M van den Bergh, Annemieke Oude Lansink-Hartgring, Franciska van der Velde, Jacinta J Maas, Pablo van de Berg, Roberto Lorusso, DelnoijThijs S RTSRDepartment of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands., Dinis Dos Reis Miranda, Erik Scholten, Fabio Silvio Taccone, Dieter F Dauwe, Erwin De Troy, Greet Hermans, Federico Pappalardo, Evgeny Fominskiy, Višnja Ivancan, Robert Bojčić, Jesse de Metz, Bas van den Bogaard, Dirk W Donker, Christiaan L Meuwese, Martin De Bakker, Benjamin Reddi, HenriquesJosé P SJPSDepartment of Cardiology, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, The Netherlands., Lars Mikael Broman, Dave A Dongelmans, and VlaarAlexander P JAPJDepartment of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. a.p.vlaar@amsterdamumc.nl..
• Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
• Crit Care. 2023 Aug 21; 27 (1): 321321.

BackgroundThrombocytopenia, hemorrhage and platelet transfusion are common in patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). However, current literature is limited to small single-center experiences with high degrees of heterogeneity. Therefore, we aimed to ascertain in a multicenter study the course and occurrence rate of thrombocytopenia, and to assess the association between thrombocytopenia, hemorrhage and platelet transfusion during VA ECMO.MethodsThis was a sub-study of a multicenter (N = 16) study on transfusion practices in patients on VA ECMO, in which a retrospective cohort (Jan-2018-Jul-2019) focusing on platelets was selected. The primary outcome was thrombocytopenia during VA ECMO, defined as mild (100-150·109/L), moderate (50-100·109/L) and severe (< 50·109/L). Secondary outcomes included the occurrence rate of platelet transfusion, and the association between thrombocytopenia, hemorrhage and platelet transfusion, assessed through mixed-effect models.ResultsOf the 419 patients included, median platelet count at admission was 179·109/L. During VA ECMO, almost all (N = 398, 95%) patients developed a thrombocytopenia, of which a significant part severe (N = 179, 45%). One or more platelet transfusions were administered in 226 patients (54%), whereas 207 patients (49%) suffered a hemorrhagic event during VA ECMO. In non-bleeding patients, still one in three patients received a platelet transfusion. The strongest association to receive a platelet transfusion was found in the presence of severe thrombocytopenia (adjusted OR 31.8, 95% CI 17.9-56.5). After including an interaction term of hemorrhage and thrombocytopenia, this even increased up to an OR of 110 (95% CI 34-360).ConclusionsThrombocytopenia has a higher occurrence than is currently recognized. Severe thrombocytopenia is strongly associated with platelet transfusion. Future studies should focus on the etiology of severe thrombocytopenia during ECMO, as well as identifying indications and platelet thresholds for transfusion in the absence of bleeding.Trial RegistrationThis study was registered at the Netherlands Trial Registry at February 26th, 2020 with number NL8413 and can currently be found at https://trialsearch.who.int/Trial2.aspx?TrialID=NL8413.© 2023. BioMed Central Ltd., part of Springer Nature.

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