Impact of Cannula Design on Packed Red Blood Cell Transfusions: Technical Advancement to Improve Outcomes in Extracorporeal Membrane Oxygenation.

Gennaro Martucci,Giovanna Pauarello,Giovanna Occhipinti,Giuseppe Raffa,Fabio Tuzzolino,Guido Capitanio,Tiziana Carollo,Giovanni Lino,Alessandro Bertani,Patrizio Vitulo,Michele Pilato,Roberto Lorusso,Antonio Arcadipane

Journal of thoracic disease（2018）SCI 4区

UPMC Italy | IRCCS ISMETT Ist Mediterraneo & Trapianti & Terap | Maastricht Univ

Cited 16|Views27

Abstract

BackgroundTechnological improvement has contributed to making veno-venous extracorporeal membrane oxygenation (VV-ECMO) safer and easier, spreading its use in acute respiratory failure (ARF).MethodsThis is a retrospective observational study carried out in the ECMO center at IRCCS-ISMETT, a medical center focused on end-stage organ failure treatment in Italy. We investigated the effect of different cannula designs on the amount of blood product transfused. Eighty-nine consecutive patients affected with ARF on VV-ECMO from 2008 to 2016 were compared according to type of cannulation: older percutaneous cannula (Standard group, 52 patients) and HLS© BIOLINE-coated, but with shorter drainage cannula (BIOLINE group, 37 patients).ResultsThe two study groups were comparable in terms of baseline characteristics [age, body mass index (BMI), Simplified Acute Physiology Score (SAPS-II), Sequential Organ Failure Assessment (SOFA), Predicting Death For Severe ARDS on VV-ECMO (PRESERVE) score] and ECMO management [median hematocrit (Htc), platelet nadir, antithrombin III (AT III), heparin, activated partial thromboplastin time (APTT)]. In the BIOLINE group, a lower amount of packed red blood cells (pRBC) was transfused considering both total number [4 units, interquartile range (IQR) 1-9 vs. 12 units, IQR 5.5-21; P<0.01] and mL of pRBC/day of ECMO support (91, IQR 21-158 vs. 193.5, IQR 140.5-254; P<0.01). In the BIOLINE group, a trend in reduction of ECMO days (P=0.05) and length of intensive care unit (ICU) stay was found (P=0.06), but no differences in rates of ECMO weaning and ICU discharge were evidenced. The BIOLINE group constituted a saving of €1,295.20 per patient/treatment, counting the costs for cannulation and pRBC administration.ConclusionsMore biocompatible and shorter drainage cannula may represent one of the contributing factors to a reduction in transfusions and costs of VV-ECMO in the current ongoing technological improvement in ECMO.

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Key words

intensive care unit (ICU) costs,large bore cannula,acute respiratory distress syndrome (ARDS),transfusion,packed red blood cells (pRBC)

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