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Ajay Desai

Royal Brompton Hospital, United Kingdom

Title: Rationalisation of blood and blood product use in neonatal and paediatric ecmo patients

Biography

Biography: Ajay Desai

Abstract

Background and Aims: Blood and blood products are an expensive and precious resource. Liberal use of blood and blood product use in ECMO patients does not improve survival rates. We hypothesised that increased sampling leads to unnecessary use of blood products in ecmo patients. We audited local clinical practice changes in blood sampling and blood-product transfusions aft er introduction of ECMO pathway and update of anti-coagulation guidelines.

Methods: We compared frequency of blood sampling and use of blood/blood products pre-Jan 2016 (Group 1, n=13) and post Jan 2016 (Group 2, n=13). Key changes introduced in Jan 2016 included a. Reduction in blood sampling frequency - 4-6 hourly to 2/day; b. No routine blood cultures during ECMO; c. ACT monitoring 1hrly to 2-4hrly when stable; d. no routine antithrombin III measurements. Th reshold for blood transfusion remained as per PICU protocol. Additional sampling only if clinically indicated. We evaluated the number of donor exposures in each group and measured cost efficiency.

Results: Th ere was signifi cant reduction in the number of blood samples in group 1. Th ere was signifi cant reduction in the use of blood/ blood products in group 2. Patients in Group 1 were exposed to signifi cantly increased number of donors. Cost implications were signifi cantly higher in Group 1 compared to Group 2. 3/11(28%) in Group 1 and 9/13(69%) in Group 2 survived PICU discharge. However, this audit was not aimed at evaluating factors for mortality in ECMO patients.

Conclusion: It is feasible to rationalise and reduce the use of blood and blood products and achieve good survival outcomes in paediatric ECMO patients.

References: 1. Murphy DA et al. Extracorporeal Membrane Oxygenation - Haemostatic complications, Tranfus Med Rev (2015). 2. Chalwin RP, Tiruvoipati R, Peek GJ. Fatal Th rombosis with activated factor VII in a paediatric patient on extracorporeal membrane oxygenation. Eur J cardiothoracic Surg 2008;34: 685-6.