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Hematological complications in children subjected to extracorporeal membrane oxygenation.

Hematological complications in children subjected to extracorporeal membrane oxygenation.
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Santiago MJ, Gómez C, Magaña I, Muñoz V, Saiz P, Sánchez A, López-Herce J,


Santiago MJ, Gómez C, Magaña I, Muñoz V, Saiz P, Sánchez A, López-Herce J, (click to view)

Santiago MJ, Gómez C, Magaña I, Muñoz V, Saiz P, Sánchez A, López-Herce J,

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Medicina intensiva 2018 03 29() pii S0210-5691(18)30049-4
Abstract
OBJECTIVES
To analyze the hematological complications and need for transfusions in children receiving extracorporeal life support (ECLS).

DESIGN
A retrospective study was carried out.

SETTING
A pediatric intensive care unit.

PATIENTS
Children under 18 years of age treated with ECLS between September 2006 and November 2015.

INTERVENTIONS
None.

VARIABLES OF INTEREST
Patient and ECLS characteristics, anticoagulation, hematological and coagulation parameters, transfusions and clinical course.

RESULTS
A total of 100 patients (94 with heart disease) with a median age of 11 months were studied. Seventy-six patients presented bleeding. The most frequent bleeding point being the mediastinum and 39 patients required revision surgery. In the first 3days, 97% of the patients required blood transfusion (34.4ml/kg per day), 94% platelets (21.1ml/kg per day) and 90% plasma (26.6ml/kg per day). Patients who were in the postoperative period, those who were bleeding at the start of ECLS, those requiring revision surgery, those who could not suspend extracorporeal circulation, and those subjected to transthoracic cannulation required a greater volume of transfusions than the rest of the patients. Thromboembolism occurred in 14 patients and hemolysis in 33 patients. Mortality among the children who were bleeding at the start of ECLS (57.6%) was significantly higher than in the rest of the patients (37.5%) (P=0.048).

CONCLUSIONS
Children treated with ECLS present high blood product needs. The main factors related to transfusions were postoperative period, bleeding at the start of ECLS, revision surgery, transthoracic cannulation, and the impossibility of suspending extracorporeal circulation. Children with bleeding suffered greater mortality than the rest of the patients.

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