Impact of extracorporeal circulation support systems on blood product resources during the course of intensive care unit treatment

Abstract

Abstract Background Extracorporeal circulatory support systems necessitate careful blood product management due to the large cannulas and exposure of blood components to artificial surfaces in the circuits. Blood component derangements can occur during implantation and the operational period of these systems, posing a significant complication. To enhance patient safety and bolster the body's own blood reserves, accurate characterization of the extent of necessary blood product substitution is imperative. Methods We analyzed data from consecutive patients who received extracorporeal circulatory support systems (Impella, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), or ECMella) over a 5-year period (2016-2021). We obtained information on blood product usage, costs, and various clinical parameters. We assessed the vascular access site according to the Bleeding Academic Research Consortium (BARC) and Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries (GUSTO) criteria, and hemolysis was evaluated using serum free hemoglobin (fHb). Results We studied 370 patients (Table 1) who received extracorporeal circulatory support systems (Impella, VA-ECMO, and ECMella) from 2016 to 2021. The median number of RBC transfusions was 7 (3 - 12) for the entire cohort, with ECMella patients requiring the highest amount (12.5 (6.7 - 27.5)) and VA-ECMO patients requiring the most within the first 24 hours (57%, p < 0.05). Hemolysis was present in all groups, with Impella patients having the highest levels (49.8 µmol / L (21.3 – 113.1), p < 0.01). ECMella patients required the highest overall blood product substitution (Figure 1) and incurred the highest associated costs (1642.4 EUR (1079.1 – 3660.3), p < 0.01). Bleeding complications in the groin area were moderate in 45% of patients, with VA-ECMO patients having the highest incidence (58%, p < 0.05). Type 3a bleeding according to the BARC criteria was most common (31.7%). Conclusion Although extracorporeal circulatory support systems have made technical advances, significant resources are still required during the operational period to maintain coagulation homeostasis, particularly in ECMella patients. Complications at the insertion site are also common, with bleeding being expected, especially in emergency situations when a VA-ECMO is used. To ensure patient safety, interdisciplinary teams should establish standardized follow-up protocols to detect peripheral complications early.