How we provide transfusion support for neonatal and pediatric patients on extracorporeal membrane oxygenation

Authors

  • Shan Yuan,

    1. From the Division of Transfusion Medicine, City of Hope National Medical Center, Duarte, California; and the Division of Transfusion Medicine, Department of Pathology & Laboratory Medicine, the Division of Cardiac Perfusion Services, and Division of Critical Care, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California.
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  • Elsa Tsukahara,

    1. From the Division of Transfusion Medicine, City of Hope National Medical Center, Duarte, California; and the Division of Transfusion Medicine, Department of Pathology & Laboratory Medicine, the Division of Cardiac Perfusion Services, and Division of Critical Care, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California.
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  • Kim De La Cruz,

    1. From the Division of Transfusion Medicine, City of Hope National Medical Center, Duarte, California; and the Division of Transfusion Medicine, Department of Pathology & Laboratory Medicine, the Division of Cardiac Perfusion Services, and Division of Critical Care, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California.
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  • Robert B. Kelly

    Corresponding author
    1. From the Division of Transfusion Medicine, City of Hope National Medical Center, Duarte, California; and the Division of Transfusion Medicine, Department of Pathology & Laboratory Medicine, the Division of Cardiac Perfusion Services, and Division of Critical Care, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California.
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Robert B. Kelly, MD, Division of Critical Care, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095; e-mail: rkelly@mednet.ucla.edu.

Abstract

Extracorporeal membrane oxygenation (ECMO) provides lifesaving hemodynamic and respiratory support to neonatal and pediatric patients with a variety of congenital or acquired cardiopulmonary defects. Successful ECMO support requires close collaboration among multiple services, including critical care medicine, perfusion, and transfusion medicine services. Neonatal and pediatric ECMO patients require significant transfusion support, both at the time of cannulation and after the ECMO circuit has been established, often with little advance notice. Thus a number of communication and logistic issues must be addressed through a multidisciplinary approach to ensure both good patient outcome and judicious use of resources. In this article, we describe our protocol for transfusion support for ECMO and potential ECMO patients, which was developed to address a number of issues, including identifying and stratifiying ECMO candidate patients, streamlining the ordering and communication processes, and improving blood product turnaround times and availability. Additional measures of quality improvement are also discussed. As the number of centers performing ECMO procedures remains high, we believe that our experience may be of interest to our colleagues in transfusion medicine and critical care.

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