Ang et al identified conditions that predict the need for blood component therapy in adults undergoing extracorporeal membrane oxygenation (ECMO) therapy. A patient who is more likely to need transfusion may benefit from more aggressive management that can reduce usage of blood products. The authors are from Singapore General Hospital, the Centre for Transfusion Medicine and National Heart Centre of Singapore.


Patient selection: adult on ECMO (venoarterial or venovenous)


Median duration of ECMO: 5 days

Longest duration: 15 days


The lowest values for hemoglobin concentration and platelet count tended to occur on the third day of ECMO.


The protocol indicated that the hemoglobin concentration should be >= 10 g/dL and the platelet count >= 100,000 per µL.


Predictors of red blood cell transfusion:

(1) low nadir hemoglobin concentration (< 7.5 g/dL)


Predictors of fresh frozen plasma (FFP) transfusion:

(1) low nadir hemoglobin concentration (< 7.5 g/dL)

(2) hypertension


Predictors of cryoprecipitate transfusion:

(1) massive transfusion protocol and low fibrinogen


Predictors of platelet transfusion:

(1) recent antiplatelet therapy

(2) larger decline in hemoglobin concentration (> 5.5 g/dL)

(3) longer ECMO duration


Predictors of long ECMO duration and total transfusion requirements:

(1) sepsis

(2) medical (non-surgical)



• Massive transfusion would increase the need for all blood usage but appears to have been uncommon in the study population. On page 39 it was stated that cryoprecipitate was seldom used.


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