(426) Platelet Mass Index and Risks of Bleeding and Clotting on Extracorporeal Membrane Oxygenation

Sunday, January 21, 2024

9:45 AM – 10:45 AM MT

Location: Connections Central - RST 12

First Author(s)

Madhuradhar Chegondi, MD (he/him/his)

Clinical Associate Professor, Division of Pediatric Critical Care Medicine
University of Iowa Stead Family Childrens's Hospital
Iowa City, IA

Co-Author(s)

Aravinth P. Jawahar, MD (he/him/his)

Pediatric Critical Care Fellow
Stead Family Children's Hospital, University of Iowa
Iowa City, Iowa, United States
LH

Lidia Hrvojevic, MPH

Research Associate
University of Iowa, United States
AB

Aditya Badheka, MD, MS

Clinical Associate Professor
University of Iowa Carver College of Medicine
Iowa City, Iowa, United States
OK

Oliver Karam, MD, PhD,

Professor of Pediatrics (Critical Care Medicine); Chief of Pediatric Critical Care, Pediatrics
Yale School of Medicine
New Haven, Connecticut, United States

Introduction: Although patients supported by ECMO are at high risk of bleeding and clotting, especially after platelet transfusions, there is very little evidence to accurately personalize the risk of bleeding and/or clotting. This has led to significant heterogeneity in ECMO patient management. Platelet mass index (PMI), which is the product of platelet count and mean platelet volume, both reported in complete blood counts, may better predict the individual risk of bleeding and clotting. We aim to assess PMI’s accuracy to predict the individual risk of bleeding and clotting.

Methods: Retrospective study of patients admitted to neonatal, pediatric, and adult ICUs at 2 ECMO centers from 6/2018-6/2022. Day-level univariable and multivariable logistic regression models, as well as area under the receiver operating characteristic (AUC) were used to assess the association and accuracy of post-transfusion PMI change and bleeding or clotting on the following day.

Results: A total of 80 patients were enrolled: 61% were males, median weight was 75 kg (IQR 13-96). median age was 40 years (IQR 3-60), and 35% were < 18 years old. ECMO type was VA in 77% of the cases, VV in 22%, and VVA in 1%. ECMO indication was cardiogenic shock in 50% of the cases, acute respiratory failure in 30%, septic shock in 5%, and E-CPR in 15%. The 28-day mortality rate on ECMO was 46%. There were a total of 314 platelet transfusions. About 30% of the patients experienced a bleeding event the following day, while 8% had a clotting event. The median pre-platelet transfusion PMI was 599 fL/nL (IQR 377-848), while the median post-transfusion PMI was 1018 fL/nL (IQR 684-1293). When adjusting for age, mode of ECMO, heparin dose, pre-transfusion platelet, and post-transfusion platelet count, the change in PMI was independently associated with following-day bleeding (adjOR 1.003, 95%CI 1.001;1.005, p< 0.001), but not following-day clotting (p=0.91). The AUC for PMI was 0.61 (95%CI 0.53;0.68) for bleeding and 0.48 (95%CI 0.35;0.60) for clotting.

Conclusions: The change in PMI after platelet transfusion seems to be independently associated with an increased risk of bleeding the following day. This study should be hypothesis-generating for future studies aimed at personalizing hemostatic management on ECMO.