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Abstract

Introduction: Pediatric Thrombocytopenia-Associated Multiple Organ Failure (TAMOF), defined as greater than 2 organ failures and platelet count < 100,000/uL, is associated with high mortality in sepsis. Plasma exchange (PEx) has been suggested to improve survival (Nguyen et al., CCM, 2008). In preliminary prospective studies of the multicenter Prospective TAMOF Network, PEx was associated with increased likelihood of survival (Fortenberry, CCM, 2011 abstr). A subset of gravely ill patients received PEx while on ECMO. We evaluated this subgroup to better determine response and outcome. Hypothesis: Patients on ECMO receiving PEx have greater severity of illness and greater likelihood of death than non-ECMO patients receiving PEx. Methods: Analysis of data from network prospective observational trial of 81 children 1 mth-21 years diagnosed with TAMOF. Pts.on ECMO receiving PEx were compared to non-ECMO pts. for severity of illness scores, outcome. ADAMTS-13 levels and platelet counts were serially obtained. Results: PEx pts had lower survival (53.8%) than non-ECMO PEx patients (79.4%; p = 0.05), but not lower than ECMO non-PEx patients (50%; p = NS). PELOD scores >21 did not predict outcome difference. PELOD scores remained higher over time in ECMO PEx pts. and in non-survivors (N-S) (p=.009). ECMO PEx pts had greater PELOD score improvement over time than non-ECMO PEx pts (p=.0077). Platelet counts were lower in non-ECMO PEx N-S, but were improved in ECMO pts vs. non-ECMO PEx, likely due to platelet therapy on ECMO. ECMO PEx survivors showed a trend for improvement in ADAMTS-13 vs. N-S (p=0.0615) and with time (p <.001). Conclusions: TAMOF patients on ECMO who received PEx were more critically ill at onset and more likely to die than TAMOF non-ECMO patients, but had significant improvement in PELOD score and reasonable survival for severity of illness. Stratification for ECMO should be considered for future PEx RCTs.