Abstract PD-042: RATIONALISING BLOOD PRODUCT USE IN PAEDIATRIC PATIENTS UNDERGOING EXTRACORPOREAL MEMBRANE OXYGENATED THERAPY

Abstract

Aims & Objectives: Liberal use of blood products in extracorporeal membrane oxygenation (ECMO) patients does not improve survival rates. We audited local clinical practice changes after update of ECMO guidelines on anti-coagulation and use of blood and blood products. Methods We compared frequency of blood sampling and use of blood products pre-January 2016 (Group 1) and post-January 2016 (Group 2) in children on ECMO. Key changes introduced in January 2016 included a. Reduction in blood count/chemistry sampling frequency from 4–6 hourly to 2/day; b. No routine blood cultures and antithrombin III measurements during ECMO; c. ACT monitoring 1hrly to 2-4hrly when stable. Threshold for blood transfusion remained as per PICU protocol. Additional sampling only if clinically indicated. Results Group 1: 13 consecutive ECMO runs (11 patients; median age: 0.6 months); Group 2: 13 consecutive ECMO runs (13 patients; median age: 8 months). Both groups had 6 patients each with univentricular circulation. There was significant reduction in the number of blood samples:132 (group 1) vs 67 (group 2). There was significant reduction in the use of blood products (ml/kg). Packed Red Cells: 255 vs 65; Fresh Frozen Plasma: 118 vs 50; Cryoprecipitate: 35 vs 15; Platelets: 122 vs 70 in groups 1 and 2 respectively. 3/11(28%) in Group 1 and 9/13(69%) in Group 2 survived PICU discharge. However, this audit did not evaluate factors for mortality in ECMO patients. Conclusions It is feasible to rationalise and reduce blood product usage in paediatric ECMO patients without increasing mortality. We will evaluate donor exposure and financial implications.