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Meta-Analysis
. 2020 Jun;46(6):1154-1169.
doi: 10.1007/s00134-020-06031-4. Epub 2020 Apr 23.

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

Federica Jiritano  1   2 , Giuseppe Filiberto Serraino  3 , Hugo Ten Cate  4 , Dario Fina  5   6 , Matteo Matteucci  5   7 , Pasquale Mastroroberto  3 , Roberto Lorusso  5
Affiliations
Meta-Analysis

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

Federica Jiritano et al. Intensive Care Med. 2020 Jun.

Abstract

Despite increasing improvement in extracorporeal membrane oxygenation (ECMO) technology and knowledge, thrombocytopenia and impaired platelet function are usual findings in ECMO patients and the underlying mechanisms are only partially elucidated. The purpose of this meta-analysis and systematic review was to thoroughly summarize and discuss the existing knowledge of platelet profile in adult ECMO population. All studies meeting the inclusion criteria (detailed data about platelet count and function) were selected, after screening literature from July 1975 to August 2019. Twenty-one studies from 1.742 abstracts were selected. The pooled prevalence of thrombocytopenia in ECMO patients was 21% (95% CI 12.9-29.0; 14 studies). Thrombocytopenia prevalence was 25.4% (95% CI 10.6-61.4; 4 studies) in veno-venous ECMO, whereas it was 23.2% (95% CI 11.8-34.5; 6 studies) in veno-arterial ECMO. Heparin-induced thrombocytopenia prevalence was 3.7% (95% CI 1.8-5.5; 12 studies). Meta-regression revealed no significant association between ECMO duration and thrombocytopenia. Platelet function impairment was described in 7 studies. Impaired aggregation was shown in 5 studies, whereas loss of platelet receptors was found in one trial, and platelet activation was described in 2 studies. Platelet transfusions were needed in up to 50% of the patients. Red blood cell transfusions were administered from 46 to 100% of the ECMO patients. Bleeding events varied from 16.6 to 50.7%, although the cause and type of haemorrhage was not consistently reported. Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode. The underlying mechanisms are multifactorial, and understanding and management are still limited. Further research to design appropriate strategies and protocols for its monitoring, management, or prevention should be matter of thorough investigations.

Keywords: Bleeding; Extracorporeal membrane oxygenation; Platelet activation; Platelet dysfunction; Platelets.

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Conflict of interest statement

Prof. Dr. Roberto Lorusso is consultant for LivaNova (principal investigator of PERSIST-AVR Trial) and Medtronic. Prof. Dr. Hugo ten Cate receives research funding from Bayer and Pfizer.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
a Forest plot of the overall prevalence of thrombocytopenia in adult ECMO patients; b forest plot of prevalence of thrombocytopenia in V-A ECMO patients; c forest plot of prevalence of thrombocytopenia in V-V ECMO patients; d forest plot of the overall prevalence of heparin-induced thrombocytopenia in adult ECMO patients
See this image and copyright information in PMC

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