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Epidemiology of Hemostatic Transfusions in Children Supported by Extracorporeal Membrane Oxygenation
Oliver Karam, MD, PhD, Ruchika Goel, MD, MPH, Heidi Dalton, MD, Marianne E. Nellis MD, MS
Supplementary Material
Table S1: Proportions of set daily hemostatic goals according to the patient location and type of ECMO Low platelet
count High ACT High aPTT Low
Fibrinogen Low AT NICU
VV (n=607 ECMO days) 568 (94%) 537 (88%) 571 (94%) 338 (56%) 117 (19%) VA (n=655 ECMO days) 624 (95%) 638 (97%) 227 (35%) 347 (53%) 209 (32%) PICU
VV (n=329 ECMO days) 306 (93%) 302 (92%) 0 (0%) 189 (57%) 99 (30%)
VA (n=1429 ECMO days) 1356 (95%) 1272 (89%) 205 (14%) 1140 (80%) 360 (25%) CICU
VV (n=34 ECMO days) 29 (85%) 30 (88%) 0 (0%) 9 (27%) 0 (0%)
VA (n=1606 ECMO days) 1453 (91%) 1358 (85%) 347 (22%) 1126 (70%) 324 (20%) NICU: neonatal intensive care unit; PICU: pediatric intensive care unit; CICU: cardiac intensive care unit; VV: veno- venous; VA: veno-arterial; ECMO: extracorporeal membrane oxygenator.
Table S2: Daily hemostatic daily goals, according to bleeding status, ECMO type (VA vs VV), and age (£ 28 days vs
> 28 days).
Low Platelet Count
High ACT High aPTT Low Fibrinogen Low AT Bleeding Status
Bleeding 100 (100;100) 200 (200;220) 70 (70;80) 150 (100;150) 80 (60;80) Non-Bleeding 100 (80;100) 220 (200;220) 80 (70;90) 150 (100;150) 75 (50;85)
p value < 0.001 < 0.001 < 0.001 < 0.001 0.79
Type of ECMO
VV 100 (100;100) 210 (200;220) 70 (60;80) 150 (100;150) 80 (60;80)
VA 100 (80;100) 210 (200;220) 80 (70;90) 150 (100;150) 70 (50;85)
p value 0.009 0.68 < 0.001 0.21 0.68
Age
£ 28 days 100 (100;100) 210 (200;220) 90 (70;100) 150 (100;150) 80 (50;90)
> 28 days 100 (80;100) 200 (200;220) 80 (70;90) 150 (100;150) 75 (60;80)
p value < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Prothrombin time goals were set for only three patient (median 15 sec, IQR 15;15) and are therefore not reported in the table.
ACT: activated clotting time (in seconds); aPTT: activated partial thromboplastin time (in seconds); AT: antithrombin (in percentage). NICU: neonatal intensive care unit; PICU: pediatric intensive care unit; CICU: cardiac intensive care unit; VV: veno-venous; VA: veno-arterial; ECMO: extracorporeal membrane oxygenator.
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Supplementary Figures
Figure S1: Histogram of the proportion of patients who had a change in daily hemostatic goals, over the course of ECMO days.
0 100 200 300 400 500
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Number of Patients on ECMO
ECMO Days
Proportion of Patients with a Change in Daily Hemostatic Goals
Change No Change
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Figure S2: Histogram of the proportion of patients who received cryoprecipitate, over the course of ECMO days.
0 100 200 300 400 500
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Number of Patients on ECMO
ECMO Days Cryoprecipitate Transfusions
No Cryoprecipiate Cryoprecipitate