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Platelets Count During Circulatory Assistance: Involvement in the Changes of Oxygenation Membrane

Received: 10 November 2021    Accepted: 29 November 2021    Published: 12 January 2022
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Abstract

Background To study the evolution of platelet count during patient treatment with Extra-Corporeal Membrane Oxygenation (ECMO) and the causes of Membrane Oxygenation (MO) exchange. Assessment of the morbidity and mortality rate was our secondary objective. Methods A single center retrospective study was conducted from January 2014 to December 2015. One-hundred and thirty-nine MO exchanges were studied over 73 patients who received 66 MO exchange. Alterations in biological parameters were compared before and after each MO exchange, to study the device-related platelet count evolution. Results Mean patient age was 56.8±13.4 years. The mean duration of the MO was 5.9±3.1 days, exchanged 26 times (68%) after clot formation. The median Survival After Veno-arterial ECMO score (SAVE score) was -3.5 [-4; -1] interquartile range [IQR]. The median Respiratory Extra-corporeal membrane Oxygenation Survival Prediction score (RESP score) was -1 [-3; 0] [IQR]. A significant decrease (p<0.001) in platelet count between the first and second MO exchange was observed in comparison with the baseline. Yet a steady decline was noted after the third MO exchange, afterwards, normalization was observed after ECMO weaning. During ECMO, a decrease in platelet count from the baseline was found after the first MO on day 2 (p<0.001), the delta was 58.000±19.000 //µL, followed by an additional significant decrease on day 3 (p=0.001). The average platelet transfusion was 0.6±1.4 units. Interestingly, the more MO was exchanged, the lesser blood products transfusion was done. The overall mortality rate was 39%; in Veno- Arterial ECMO (VA-ECMO) it was 34.48% and 41.38% in Veno-Venous ECMO (VV-ECMO). Conclusion Clot formation is the leading cause of MO exchange during ECMO. Therefore, there is a significant decrease in platelets count starting from day 2 that indicates platelets transfusions in order to prevent complications of hemostasis.

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 8, Issue 1)
DOI 10.11648/j.ijcts.20220801.11
Page(s) 1-7
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Platelets, Membrane Oxygenation, ECMO, ECLS, SAVE Score, RESP Score, Cardiac Surgery

References
[1] MacLaren G, Combes A, Bartlett RH. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med. 2012; 38: 210-20. DOI: 10.1007//s00134-011-2439-2.
[2] Extracorporeal Life Support Organization - ECMO and ECLS. URL https://www.elso.org//resources//guidelines.aspx (accessed 4.10.18).
[3] von Bahr V, Hultman J, Eksborg S, Frenckner B, Kalzen H. Long-Term Survival in Adults Treated With Extracorporeal Membrane Oxygenation for Respiratory Failure and Sepsis. Crit Care Med. 2017; 45: 164-70. DOI: 10.1097//CCM.0000000000002078.
[4] Wahba A, Philipp A, Behr R, Birnbaum DE. Heparin-Coated Equipment Reduces the Risk of Oxygenator Failure. Ann Thorac Surg. 1998; 65: 1310-2. DOI: 10.1016//S0003-4975(98)00156-8.
[5] Wendel HP, Philipp A, Weber N, Birnbaum DE, Ziemer G. Oxygenator thrombosis: worst case after development of an abnormal pressure gradient--incidence and pathway. Perfusion. 2001; 16: 271-8. DOI: 10.1177//026765910101600402.
[6] Stallion A, Cofer BR, Rafferty JA, Ziegler MM, Ryckman FC. The significant relationship between platelet count and haemorrhagic complications on ECMO. Perfusion. 1994; 9: 265-9. DOI: 10.1177//026765919400900404.
[7] Da Broi U, Adami V, Falasca E, Malangone W, Crini S, Degrassi A. A new oxygenator change-out system and procedure. Perfusion. 2006; 21: 297-303. DOI: 10.1177//0267659106074771.
[8] Allen S, Holena D, McCunn M, Kohl B, Sarani B. A review of the fundamental principles and evidence base in the use of extracorporeal membrane oxygenation (ECMO) in critically ill adult patients. J Intensive Care Med. 2011; 26: 13-26. DOI: 10.1177//0885066610384061.
[9] Schaadt J. Oxygenator thrombosis: an international phenomenon. Perfusion. 1999; 14: 425-35. DOI: 10.1177//026765919901400605.
[10] Robinson TM, Kickler TS, Walker LK, Ness P, Bell W. Effect of extracorporeal membrane oxygenation on platelets in newborns. Crit Care Med. 1993; 21: 1029-34. DOI: 10.1097//00003246-199307000- 00018}.
[11] Dornia C, Philipp A, Bauer S, Hoffstetter P, Lehle K, Schmid C, et al. Visualization of thrombotic deposits in extracorporeal membrane oxygenation devices using multidetector computed tomography: a feasibility study. ASAIO J. 2013; 59: 439-41. DOI: 10.1097//MAT.0b013e3182976eff.
[12] University of Utah. Platelet Function During ECMO (Extra Corporeal Membrane Oxygenation). https://ClinicalTrials.gov//show//NCT00748878; 2008 [updated June].
[13] Ang AL, Teo D, Lim CH, Leou KK, Tien SL, Koh MB. Blood transfusion requirements and independent predictors of increased transfusion requirements among adult patients on extracorporeal membrane oxygenation -- a single centre experience. Vox Sang. 2009; 96: 34-43. DOI: 10.1111//j.1423- 0410.2008.01110.x.
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    Alaa Azhari, Ehab Kasem, Mohammed Miny, Adama Sawadogo, Nicolas D’ostrevy, et al. (2022). Platelets Count During Circulatory Assistance: Involvement in the Changes of Oxygenation Membrane. International Journal of Cardiovascular and Thoracic Surgery, 8(1), 1-7. https://doi.org/10.11648/j.ijcts.20220801.11

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    ACS Style

    Alaa Azhari; Ehab Kasem; Mohammed Miny; Adama Sawadogo; Nicolas D’ostrevy, et al. Platelets Count During Circulatory Assistance: Involvement in the Changes of Oxygenation Membrane. Int. J. Cardiovasc. Thorac. Surg. 2022, 8(1), 1-7. doi: 10.11648/j.ijcts.20220801.11

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    AMA Style

    Alaa Azhari, Ehab Kasem, Mohammed Miny, Adama Sawadogo, Nicolas D’ostrevy, et al. Platelets Count During Circulatory Assistance: Involvement in the Changes of Oxygenation Membrane. Int J Cardiovasc Thorac Surg. 2022;8(1):1-7. doi: 10.11648/j.ijcts.20220801.11

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  • @article{10.11648/j.ijcts.20220801.11,
      author = {Alaa Azhari and Ehab Kasem and Mohammed Miny and Adama Sawadogo and Nicolas D’ostrevy and Celine Lambert and Bruno Pereira and Kazra Azarnoush and Lionel Camilleri},
      title = {Platelets Count During Circulatory Assistance: Involvement in the Changes of Oxygenation Membrane},
      journal = {International Journal of Cardiovascular and Thoracic Surgery},
      volume = {8},
      number = {1},
      pages = {1-7},
      doi = {10.11648/j.ijcts.20220801.11},
      url = {https://doi.org/10.11648/j.ijcts.20220801.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20220801.11},
      abstract = {Background To study the evolution of platelet count during patient treatment with Extra-Corporeal Membrane Oxygenation (ECMO) and the causes of Membrane Oxygenation (MO) exchange. Assessment of the morbidity and mortality rate was our secondary objective. Methods A single center retrospective study was conducted from January 2014 to December 2015. One-hundred and thirty-nine MO exchanges were studied over 73 patients who received 66 MO exchange. Alterations in biological parameters were compared before and after each MO exchange, to study the device-related platelet count evolution. Results Mean patient age was 56.8±13.4 years. The mean duration of the MO was 5.9±3.1 days, exchanged 26 times (68%) after clot formation. The median Survival After Veno-arterial ECMO score (SAVE score) was -3.5 [-4; -1] interquartile range [IQR]. The median Respiratory Extra-corporeal membrane Oxygenation Survival Prediction score (RESP score) was -1 [-3; 0] [IQR]. A significant decrease (p<0.001) in platelet count between the first and second MO exchange was observed in comparison with the baseline. Yet a steady decline was noted after the third MO exchange, afterwards, normalization was observed after ECMO weaning. During ECMO, a decrease in platelet count from the baseline was found after the first MO on day 2 (p<0.001), the delta was 58.000±19.000 //µL, followed by an additional significant decrease on day 3 (p=0.001). The average platelet transfusion was 0.6±1.4 units. Interestingly, the more MO was exchanged, the lesser blood products transfusion was done. The overall mortality rate was 39%; in Veno- Arterial ECMO (VA-ECMO) it was 34.48% and 41.38% in Veno-Venous ECMO (VV-ECMO). Conclusion Clot formation is the leading cause of MO exchange during ECMO. Therefore, there is a significant decrease in platelets count starting from day 2 that indicates platelets transfusions in order to prevent complications of hemostasis.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Platelets Count During Circulatory Assistance: Involvement in the Changes of Oxygenation Membrane
    AU  - Alaa Azhari
    AU  - Ehab Kasem
    AU  - Mohammed Miny
    AU  - Adama Sawadogo
    AU  - Nicolas D’ostrevy
    AU  - Celine Lambert
    AU  - Bruno Pereira
    AU  - Kazra Azarnoush
    AU  - Lionel Camilleri
    Y1  - 2022/01/12
    PY  - 2022
    N1  - https://doi.org/10.11648/j.ijcts.20220801.11
    DO  - 10.11648/j.ijcts.20220801.11
    T2  - International Journal of Cardiovascular and Thoracic Surgery
    JF  - International Journal of Cardiovascular and Thoracic Surgery
    JO  - International Journal of Cardiovascular and Thoracic Surgery
    SP  - 1
    EP  - 7
    PB  - Science Publishing Group
    SN  - 2575-4882
    UR  - https://doi.org/10.11648/j.ijcts.20220801.11
    AB  - Background To study the evolution of platelet count during patient treatment with Extra-Corporeal Membrane Oxygenation (ECMO) and the causes of Membrane Oxygenation (MO) exchange. Assessment of the morbidity and mortality rate was our secondary objective. Methods A single center retrospective study was conducted from January 2014 to December 2015. One-hundred and thirty-nine MO exchanges were studied over 73 patients who received 66 MO exchange. Alterations in biological parameters were compared before and after each MO exchange, to study the device-related platelet count evolution. Results Mean patient age was 56.8±13.4 years. The mean duration of the MO was 5.9±3.1 days, exchanged 26 times (68%) after clot formation. The median Survival After Veno-arterial ECMO score (SAVE score) was -3.5 [-4; -1] interquartile range [IQR]. The median Respiratory Extra-corporeal membrane Oxygenation Survival Prediction score (RESP score) was -1 [-3; 0] [IQR]. A significant decrease (p<0.001) in platelet count between the first and second MO exchange was observed in comparison with the baseline. Yet a steady decline was noted after the third MO exchange, afterwards, normalization was observed after ECMO weaning. During ECMO, a decrease in platelet count from the baseline was found after the first MO on day 2 (p<0.001), the delta was 58.000±19.000 //µL, followed by an additional significant decrease on day 3 (p=0.001). The average platelet transfusion was 0.6±1.4 units. Interestingly, the more MO was exchanged, the lesser blood products transfusion was done. The overall mortality rate was 39%; in Veno- Arterial ECMO (VA-ECMO) it was 34.48% and 41.38% in Veno-Venous ECMO (VV-ECMO). Conclusion Clot formation is the leading cause of MO exchange during ECMO. Therefore, there is a significant decrease in platelets count starting from day 2 that indicates platelets transfusions in order to prevent complications of hemostasis.
    VL  - 8
    IS  - 1
    ER  - 

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Author Information
  • Departement of Cardiovascular Surgery, University of Clermont-Auvergne, Clermont-Ferrand, France

  • Departement of Cardiovascular and Thoracic Surgery, University of Zagazig, Sharkia, Egypt

  • Departement of Cardiovascular Surgery, King Abdullah Medical City, Makkah, Saudi Arabia

  • Departement of Cardiovascular Surgery, University of Clermont-Auvergne, Clermont-Ferrand, France

  • Departement of Cardiovascular and Thoracic Surgery, University Hospital of Tendango, Ouagadogo, Burkina Faso

  • Departement of Biostatistics, University of Clermont-Auvergne, Clermont-Ferrand, France

  • Departement of Biostatistics, University of Clermont-Auvergne, Clermont-Ferrand, France

  • Departement of Cardiovascular and Thoracic Surgery, University Hospital of Tendango, Ouagadogo, Burkina Faso

  • Departement of Cardiovascular and Thoracic Surgery, University Hospital of Tendango, Ouagadogo, Burkina Faso

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