Patient-tailored platelet transfusion practices for children supported by extracorporeal membrane oxygenation

Background and Objectives: Extracorporeal membrane oxygenation (ECMO) serves as cardiopulmonary therapy in critically ill patients with respiratory/heart failure and often necessitates multiple blood product transfusions. The administration of platelet transfusions during ECMO is triggered by the presence or risk of significant bleeding. Most paediatric ECMO programmes follow guidelines that recommend a platelet transfusion threshold of 80–100 × 10⁹/L. To reduce exposure to platelets, we developed a practice to dynamically lower the threshold to ~20 × 10⁹/L. We describe our experience with patient-tailored platelet thresholds and related bleeding outcomes. Materials and Methods: We retrospectively evaluated our platelet transfusion policy, bleeding complications and patient outcome in 229 ECMO-supported paediatric patients in our unit. Results: We found that more than 97.4% of patients had a platelet count <100 × 10⁹/L at some point during their ECMO course. Platelets were transfused only on 28.5% of ECMO days; and 19.2% of patients never required a platelet transfusion. The median lowest platelet count in children who had bleeding events was 25 × 10⁹/L as compared to 33 × 10⁹/L in children who did not bleed (p < 0.001). Our patients received fewer platelet transfusions and did not require more red blood cell transfusions, nor did they experience more haemorrhagic complications. Conclusion: We have shown that a restrictive, ‘patient-tailored’ rather than ‘goal-directed’ platelet transfusion policy is feasible and safe, which can greatly reduce the use of platelet products. Although there was a difference in the lowest platelet counts in children who bled versus those who did not, the median counts were much lower than current recommendations.