DECREASING BLOOD-DONOR EXPOSURE IN NEONATES ON EXTRACORPOREAL MEMBRANE-OXYGENATION

Extracorporeal membrane oxygenation (ECMO) has been successful treatment (80% survival) in over 2,000 neonates with severe respiratory failure (80% predicted mortality without ECMO). Neonates on ECMO require frequent blood product replacement, which increases donor exposure (DE) and the risk of transfusion related complications. Successful, widespread usage of ECMO in neonatal respiratory failure is placing increased numbers of surviving infants at risk for acute and long-term transfusion related problems. We assessed DE rates in 21 consecutive neonatal ECMO survivors. In the first 12 patients packed red blood cell (PRBC) transfusions were administered as 10 mL/kg body weight for hematocrit less than 45%. PRBC exchange transfusions were used in patients with hematocrit less than 45% and hypervolemia. Fresh frozen plasma (FFP) and cryoprecipitate (CRYO) infusions were used empirically for evidence of hemorrhage. DE rates (donors per ECMO day, mean±SD) were: PRBC (2.8±0.6), FFP/CRYO (0.5±0.7), and platelet (2.0±1.0), with a total donor exposure rate of 5.3±2.0 donors per ECMO day. Mean duration of ECMO was 4.6±2.0 days and total DE per infant was 22.8±9.5 donors per ECMO run. In a protocol (n=9) to minimize DE risks, exchange transfusions were eliminated and PRBC transfusion volumes were increased to 15 mL/kg. Empiric use of FFP and CRYO was discontinued. The blood bank divided standard units of PRBCs into four aliquots and dispensed each aliquot sequentially before dispensing blood from another unit. PRBC donor exposure rate declined 50% from 2.8±0.6 to 1.4±0.6 donors per ECMO day (P=.0001) and total DE rate decreased 43% from 5.3±2.0 to 3.0±1.1 donors per ECMO day (P=.005). Mean ECMO days, platelet usage, and complication rates were unchanged. A significant reduction in PRBC and total DE rates was explained by elimination of PRBC exchange transfusions, discontinuation of FFP and CRYO infusions, and increased transfusion volumes with 15 cc/kg body weight PRBCs from designated, multialiquoted PRBC units sequentially dispensed. These practices appear to be safe and can minimize transfusion related risks in this group of critically ill neonates. © 1990 W.B. Saunders Company.