Skip to main content
SpringerLink
Log in
Book cover

Neonatal Transfusion Practices pp 103–121Cite as

Transfusion Considerations for Neonatal Extracorporeal Membrane Oxygenation (ECMO)

  • Chapter
  • First Online:

Abstract

Extracorporeal membrane oxygenation (ECMO), modified cardiopulmonary bypass, is a life-saving procedure for neonates with reversible cardiorespiratory failure. This complex, invasive therapy requires a skilled multidisciplinary team to achieve optimal results. Ready access to blood products is critical and transfusion services are vital in the care of a patient receiving ECMO. Blood products (red blood cells, platelets, and plasma) are a constant requirement during this form of ongoing massive transfusion in the neonatal patient. Complications, such as hemorrhage and clotting in the circuit, must be monitored through the ECMO course via tests assessing the integrity of the coagulation cascade as well as heparin therapy. Over the decades, intact survival rates continue to improve for neonates.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   74.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   84.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. AABB, Clinical Transfusion Medicine Committee. AABB Committee Report: reducing transfusion-transmitted cytomegalovirus infections. Transfusion. 2016;56(6 Pt 2):1581–7.

    Article  Google Scholar 

  2. Anderson HL 3rd, Snedecor S. Multicenter comparison of conventional venoarterial access versus venovenous double-lumen catheter access in newborn infants undergoing extracorporeal membrane oxygenation. J Pediatr Surg. 1993;28(4):530–4.

    Google Scholar 

  3. Ang AL, Teo D. 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(1):34–43.

    Article  CAS  PubMed  Google Scholar 

  4. Annich G, Lynch WR, MacLaren G, Wilson JM, Barlett RH, editors. ECMO extracorporeal cardiopulmonary support in critical care. 4th ed. Ann Arbor: ELSO; 2012.

    Google Scholar 

  5. Baker-Groberg SM, Lattimore S, et al. Assessment of neonatal platelet adhesion, activation, and aggregation. J Thromb Haemost. 2016;14(4):815–27.

    Article  CAS  PubMed  Google Scholar 

  6. Barrett CS, Jaggers JJ, et al. Outcomes of neonates undergoing extracorporeal membrane oxygenation support using centrifugal versus roller blood pumps. Ann Thorac Surg. 2012;94(5):1635–41.

    Article  PubMed  Google Scholar 

  7. Bartlett RH, Roloff DW, et al. Extracorporeal life support: the University of Michigan experience. JAMA. 2000;283(7):904–8.

    Article  CAS  PubMed  Google Scholar 

  8. Bembea MM, Annich G, et al. Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: an international survey. Pediatr Crit Care Med. 2013;14(2):e77–84.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bembea MM, Schwartz JM, et al. Anticoagulation monitoring during pediatric extracorporeal membrane oxygenation. ASAIO J. 2013;59(1):63–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Bennett CC, Johnson A, UK Collaborative ECMO Trial Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation: follow-up to age 4 years. Lancet. 2001;357(9262):1094–6.

    Article  CAS  PubMed  Google Scholar 

  11. Bjerke HS, Kelly Jr RE, et al. Decreasing transfusion exposure risk during extracorporeal membrane oxygenation (ECMO). Transfus Med. 1992;2(1):43–9.

    Article  CAS  PubMed  Google Scholar 

  12. Boodram S, Evans E. Use of leukocyte-depleting filters during cardiac surgery with cardiopulmonary bypass: a review. J Extra Corpor Technol. 2008;40(1):27–42.

    PubMed  PubMed Central  Google Scholar 

  13. Bui JD, Despotis GD, et al. Fatal thrombosis after administration of activated prothrombin complex concentrates in a patient supported by extracorporeal membrane oxygenation who had received activated recombinant factor VII. J Thorac Cardiovasc Surg. 2002;124(4):852–4.

    Article  PubMed  Google Scholar 

  14. Chevuru SC, Sola MC, Florida Collaborative Neonatology Research Group. Multicenter analysis of platelet transfusion usage among neonates on extracorporeal membrane oxygenation. Pediatrics. 2002;109(6):e89.

    Article  PubMed  Google Scholar 

  15. Diab YA, Wong EC, Luban NL. Massive transfusion in children and neonates. Br J Haematol. 2013;161(1):15–26.

    Article  PubMed  Google Scholar 

  16. Dodd RY. Emerging infections, transfusion safety, and epidemiology. N Engl J Med. 2003;349(13):1205–6.

    Article  PubMed  Google Scholar 

  17. Downard CD, Betit P, et al. Impact of AMICAR on hemorrhagic complications of ECMO: a ten-year review. J Pediatr Surg. 2003;38(8):1212–6.

    Article  PubMed  Google Scholar 

  18. Durandy Y. The impact of vacuum-assisted venous drainage and miniaturized bypass circuits on blood transfusion in pediatric cardiac surgery. ASAIO J. 2009;55(1):117–20.

    Article  PubMed  Google Scholar 

  19. ELSO. ELSO Anticoagulation Guidelines. 2016. Retrieved from elso.org: https://www.elso.org/portals/0/files/elsoanticoagulationguideline8-2014-table-contents.pdf.

  20. Ferrer-Marin F, Stanworth S, et al. Distinct differences in platelet production and function between neonates and adults: implications for platelet transfusion practice. Transfusion. 2013;53(11):2814–21.

    Article  PubMed  Google Scholar 

  21. Fiser RT, Irby K, et al. RBC transfusion in pediatric patients supported with extracorporeal membrane oxygenation: is there an impact on tissue oxygenation? Pediatr Crit Care Med. 2014;15(9):806–13.

    Article  PubMed  Google Scholar 

  22. Annich GM. Extracorporeal life support: the precarious balance of hemostasis. J Thromb Haemost. 2015;13 Suppl 1:S336–42.

    Article  PubMed  Google Scholar 

  23. Hardart GE, Fackler JC. Predictors of intracranial hemorrhage during neonatal extracorporeal membrane oxygenation. J Pediatr. 1999;134(2):156–9.

    Article  CAS  PubMed  Google Scholar 

  24. Henríquez-Henríquez M, Kattan J, et al. Blood component usage during extracorporeal membrane oxygenation: experience in 98 patients at a Latin-American tertiary hospital. Int J Artif Organs. 2014;37(3):233–40.

    Article  PubMed  Google Scholar 

  25. Hervey-Jumper SL, Annich GM. Neurological complications of extracorporeal membrane oxygenation in children. J Neurosurg Pediatr. 2011;7(4):338–44.

    Article  PubMed  Google Scholar 

  26. Jackson HT, Oyetunji TA, et al. The impact of leukoreduced red blood cell transfusion on mortality of neonates undergoing extracorporeal membrane oxygenation. J Surg Res. 2014;192(1):6–11.

    Article  PubMed  Google Scholar 

  27. Karimova A, Brown K, et al. Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK. Arch Dis Child Fetal Neonatal Ed. 2009;94(2):F129–32.

    Article  CAS  PubMed  Google Scholar 

  28. Khaja WA, Bilen O, et al. Evaluation of heparin assay for coagulation management in newborns undergoing ECMO. Am J Clin Pathol. 2010;134(6):950–4.

    Article  CAS  PubMed  Google Scholar 

  29. Khoshbin E, Westrope C, et al. Performance of polymethyl pentene oxygenators for neonatal extracorporeal membrane oxygenation: a comparison with silicone membrane oxygenators. Perfusion. 2005;20(3):129–34.

    Article  PubMed  Google Scholar 

  30. Kipps AK, Wypij D, et al. Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery. Pediatr Crit Care Med. 2011;12(1):52–6.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Krisa VM, Kevin L, Peek G, Joseph Z, editors. ECMO extracorporeal cardiopulmonary support in critical care. 3rd ed. Ann Arbor: ELSO; 2005.

    Google Scholar 

  32. Kulat B, Zingle N. Optimizing circuit design using a remote-mounted perfusion system. J Extra Corpor Technol. 2009;41(1):28–31.

    PubMed  PubMed Central  Google Scholar 

  33. Lequier L, Horton SB, et al. Extracorporeal membrane oxygenation circuitry. Pediatr Crit Care Med. 2013;14(5 Suppl 1):S7–12.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Li G, Rachmale S, et al. Incidence and transfusion risk factors for transfusion-associated circulatory overload among medical intensive care unit patients. Transfusion. 2011;51(2):338–43.

    Article  PubMed  Google Scholar 

  35. Liveris A, Bello RA, et al. Anti-factor Xa assay is a superior correlate of heparin dose than activated partial thromboplastin time or activated clotting time in pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2014;15(2):e72–9.

    Article  PubMed  Google Scholar 

  36. Madar J, Richmond S. Role of extracorporeal membrane oxygenation. Lancet. 1996;348(9030):823–4.

    Article  CAS  PubMed  Google Scholar 

  37. Masalunga C, Cruz M, et al. Increased hemolysis from saline pre-washing RBCs or centrifugal pumps in neonatal ECMO. J Perinatol. 2007;27(6):380–4.

    Article  CAS  PubMed  Google Scholar 

  38. McCoy-Pardington D, Judd WJ, et al. Blood use during extracorporeal membrane oxygenation. Transfusion. 1990;30(4):307–9.

    Article  CAS  PubMed  Google Scholar 

  39. Minifee PK, et al. Decreasing blood donor exposure in neonates on extracorporeal membrane oxygenation. J Pediatr Surg. 1990;25(1):38–42.

    Article  CAS  PubMed  Google Scholar 

  40. Mok YH, Lee J. Neonatal extracorporeal membrane oxygenation: update on management strategies and long-term outcomes. Adv Neonatal Care. 2016;16(1):26–36.

    Article  PubMed  Google Scholar 

  41. Nankervis CA, Preston TJ, et al. Assessing heparin dosing in neonates on venoarterial extracorporeal membrane oxygenation. ASAIO J. 2007;53(1):111–4.

    Article  CAS  PubMed  Google Scholar 

  42. Niebler RA, Christensen M, et al. Antithrombin replacement during extracorporeal membrane oxygenation. Artif Organs. 2011;35(11):1024–8.

    Article  CAS  PubMed  Google Scholar 

  43. Luban NL. Neonatal red blood cell transfusions. Vox Sang. 2004;87 Suppl 2:184–8.

    Article  PubMed  Google Scholar 

  44. Ortolano GA, Aldea GS, et al. A review of leukofiltration in cardiac surgery: the time course of reperfusion injury may facilitate study design of anti-inflammatory effects. Perfusion. 2002;17(Suppl):53–62.

    Article  PubMed  Google Scholar 

  45. Osiovich HC, Peliowski A, et al. The Edmonton experience with venovenous extracorporeal membrane oxygenation. J Pediatr Surg. 1998;33(12):1749–52.

    Article  CAS  PubMed  Google Scholar 

  46. Paden ML, Paden ML, Rycus PL, Thiagarajan PR, ELSO Registry. Update and outcomes in extracorporeal life support. Semin Perinatol. 2014;38(2):65–70.

    Article  PubMed  Google Scholar 

  47. Pandey S, Vyas GN. Adverse effects of plasma transfusion. Transfusion. 2012;52 Suppl 1:65S–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Perry R, Stein J, et al. Antithrombin III administration in neonates with congenital diaphragmatic hernia during the first three days of extracorporeal membrane oxygenation. J Pediatr Surg. 2013;48(9):1837–42.

    Article  PubMed  Google Scholar 

  49. Polito A, Barrett CS, et al. Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data. Intensive Care Med. 2013;39(9):1594–601.

    Article  CAS  PubMed  Google Scholar 

  50. Qureshi FG, Jackson HT, et al. The changing population of the United States and use of extracorporeal membrane oxygenation. J Surg Res. 2013;184(1):572–6.

    Article  PubMed  Google Scholar 

  51. Rosenberg EM, Chambers LA, et al. A program to limit donor exposures to neonates undergoing extracorporeal membrane oxygenation. Pediatrics. 1994;94(3):341–6.

    CAS  PubMed  Google Scholar 

  52. Salvin JW, Scheurer MA, et al. Blood transfusion after pediatric cardiac surgery is associated with prolonged hospital stay. Ann Thorac Surg. 2011;91(1):204–10.

    Article  PubMed  Google Scholar 

  53. Smith A, Hardison D, et al. Red blood cell transfusion volume and mortality among patients receiving extracorporeal membrane oxygenation. Perfusion. 2013;28(1):54–60.

    Article  PubMed  Google Scholar 

  54. Smith KM, McMullan DM, et al. Is age at initiation of extracorporeal life support associated with mortality and intraventricular hemorrhage in neonates with respiratory failure? J Perinatol. 2014;34(5):386–91.

    Article  CAS  PubMed  Google Scholar 

  55. Sulkowski JP, Preston TJ, et al. Comparison of routine laboratory measures of heparin anticoagulation for neonates on extracorporeal membrane oxygenation. J Extra Corpor Technol. 2014;46(1):69–76.

    PubMed  PubMed Central  Google Scholar 

  56. Syburra T, Lachat M, et al. Fatal outcome of recombinant factor VIIa in heart transplantation with extracorporeal membrane oxygenation. Ann Thorac Surg. 2010;89(5):1643–5.

    Article  PubMed  Google Scholar 

  57. Urlesberger B, Zobel G, et al. Activation of the clotting system during extracorporeal membrane oxygenation in term newborn infants. J Pediatr. 1996;129(2):264–8.

    Article  CAS  PubMed  Google Scholar 

  58. Usher R, Shephard M, Lind J. The blood volume of the newborn infant and placental transfusion. Acta Paediatr. 1963;52:497–512.

    Article  CAS  PubMed  Google Scholar 

  59. Velik-Salchner C, Sergi C. Use of recombinant factor VIIa (Novoseven) in combination with other coagulation products led to a thrombotic occlusion of the truncus brachiocephalicus in a neonate supported by extracorporeal membrane oxygenation. Anesth Analg. 2005;101(3):924.

    Article  PubMed  Google Scholar 

  60. Vlaar AP, Binnekade JM, et al. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case–control study. Crit Care Med. 2010;38(3):771–8.

    Article  PubMed  Google Scholar 

  61. Wylie MC, Graham DA, et al. Risk factors for central line-associated bloodstream infection in pediatric intensive care units. Infect Control Hosp Epidemiol. 2010;31(10):1049–56.

    Article  PubMed  Google Scholar 

  62. Yuan S, Tsukahara E, et al. How we provide transfusion support for neonatal and pediatric patients on extracorporeal membrane oxygenation. Transfusion. 2013;53(6):1157–65.

    Article  PubMed  Google Scholar 

  63. Zavadil DP, Stammers AH, et al. Hematological abnormalities in neonatal patients treated with extracorporeal membrane oxygenation (ECMO). J Extra Corpor Technol. 1998;30(2):83–90.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA

    Ursula Nawab

  2. ECMO Center, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd., 2NW66 Main Hospital, Philadelphia, PA, USA

    Susan B. Williams RN, BSW, RNC-NIC

Authors
  1. Ursula Nawab
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan B. Williams RN, BSW, RNC-NIC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ursula Nawab .

Editor information

Editors and Affiliations

  1. Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Deborah A. Sesok-Pizzini

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Nawab, U., Williams, S.B. (2017). Transfusion Considerations for Neonatal Extracorporeal Membrane Oxygenation (ECMO). In: Sesok-Pizzini, D. (eds) Neonatal Transfusion Practices. Springer, Cham. https://doi.org/10.1007/978-3-319-42764-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42764-5_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42762-1

  • Online ISBN: 978-3-319-42764-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation