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Consumption of blood products during mechanical circulatory support in children: comparison between ECMO and a pulsatile ventricular assist device

  • Neonatal and Pediatric Intensive Care
  • Published:
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Abstract

Objective

Different mechanical circulatory support (MCS) systems are used in children with intractable heart failure. However, the need for anticoagulation leads to hemorrhage with subsequent use of blood products. We compared the coagulation disorders and the need for blood products in children treated either with extracorporeal membrane oxygenation (ECMO) or with the Berlin Heart pulsatile pneumatic ventricular assist device.

Patients

We retrospectively reviewed the first 8-day course of 64 children who were on MCS for more than 2 days between 1990 and 2002. Thirty children (median age 7.4 years, weight 25.5 kg) received Berlin Heart support and 34 children (median age 1.8 years, weight 9.2 kg) ECMO. Anticoagulation was accomplished by continuous infusion of heparin. Red blood cell count, platelet count, aPTT, AT III, fibrinogen, and ACT were measured regularly. Depending on blood loss and the coagulation disorder, red blood cells, fresh frozen plasma, platelets, and AT III were substituted.

Results

There were no preoperative differences in hematological parameters between the two groups. In the Berlin Heart group platelet transfusion was 4.3 ml·kg·day vs 24.6 ml·kg·day in the ECMO group. Red blood cell substitution was 17.2 vs 60.3 ml·kg·day. Fresh frozen plasma substitution was 8.5 ml·kg·day vs 46.9 ml·kg·day (P<0.001). Even in the congenital heart defect subgroups, when MCS was implanted without recent cardiotomy, the differences were significant. Nevertheless, the mean daily values for hemoglobin, platelets, and fibrinogen were lower in the ECMO group. There was lower overall mortality in the Berlin Heart group.

Conclusions

Compared to ECMO, use of the Berlin Heart in children results in less blood loss and lower consumption of red blood cells, platelets, and fresh frozen plasma.

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Acknowledgement

We are grateful for statistical calculations by Julia Stein and editorial assistance by Anne Gale, both of the Deutsches Herzzentrum Berlin, Germany

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Brigitte Stiller, Julia Lemmer & Peter E. Lange

  2. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany

    Vladimir Alexi-Meskishvili, Yuguo Weng, Michael Hübler, Thorsten Drews & Roland Hetzer

  3. Academy for Perfusionists, Berlin, Germany

    Frank Merkle

  4. Department of Anesthesia, Deutsches Herzzentrum Berlin, Germany

    Andreas Koster

Authors
  1. Brigitte Stiller
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  2. Julia Lemmer
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  3. Frank Merkle
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  4. Vladimir Alexi-Meskishvili
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  5. Yuguo Weng
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  6. Michael Hübler
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  7. Andreas Koster
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  8. Thorsten Drews
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  9. Peter E. Lange
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  10. Roland Hetzer
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Corresponding author

Correspondence to Brigitte Stiller.

Additional information

Conflict of interest: Dr. Roland Hetzer received 4,000 Euros per year as consultant from the company Berlin Heart

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Stiller, B., Lemmer, J., Merkle, F. et al. Consumption of blood products during mechanical circulatory support in children: comparison between ECMO and a pulsatile ventricular assist device. Intensive Care Med 30, 1814–1820 (2004). https://doi.org/10.1007/s00134-004-2352-z

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  • DOI: https://doi.org/10.1007/s00134-004-2352-z

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