Transfusion Thresholds for Adult Respiratory Extracorporeal Life Support: An Expert Consensus Document

Severe acute respiratory distress syndrome (ARDS) can complicate novel pandemic coronavirus disease (COVID-19). Extracorporeal life support (ECLS) represents the final possible rescue strategy. Variations in practice, combined with a paucity of rigourous guidelines, may complicate blood-product reso...

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Bibliographic Details
Published in:Canadian journal of cardiology 2020-09, Vol.36 (9), p.1550-1553
Main Authors: Singh, Gurmeet, Nahirniak, Susan, Arora, Rakesh, Légaré, Jean-François, Kanji, Hussein D., Nagpal, Dave, Lamarche, Yoan, Fan, Eddy, Singh Parhar, Ken Kuljit
Format: Article
Language:English
Subjects:
Adult
Anemia - blood
Anemia - etiology
Anemia - therapy
Anticoagulants - classification
Anticoagulants - therapeutic use
Betacoronavirus
Blood Coagulation Tests - methods
Blood Component Transfusion - methods
Canada
Consensus
Coronavirus Infections - complications
COVID-19
Extracorporeal Membrane Oxygenation - adverse effects
Extracorporeal Membrane Oxygenation - methods
Humans
Pandemics
Pneumonia, Viral - complications
Respiratory Distress Syndrome - blood
Respiratory Distress Syndrome - etiology
Respiratory Distress Syndrome - therapy
SARS-CoV-2
Thrombosis - blood
Thrombosis - etiology
Thrombosis - prevention & control
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Summary:Severe acute respiratory distress syndrome (ARDS) can complicate novel pandemic coronavirus disease (COVID-19). Extracorporeal life support (ECLS) represents the final possible rescue strategy. Variations in practice, combined with a paucity of rigourous guidelines, may complicate blood-product resource availability and allocation during a pandemic. We conducted a literature review around venovenous extracorporeal membrane oxygenation (VV-ECMO) transfusion practices for platelets, packed red blood cells, fresh frozen plasma, prothrombin complex concentrate, and antithrombin. Pertinent society guidelines were examined, and the practice of Canadian ECLS experts was sampled through an environmental scan. This paper represents a synthesis of these explorations, combined with input from the Canadian Cardiovascular Critical Care (CANCARE) Society, Canadian Society of Cardiac Surgeons, and the Canadian Critical Care Society. We offer a pragmatic guidance document for restrictive transfusion thresholds in nonbleeding patients on VV-ECMO, which may attenuate transfusion-related complications and simultaneously shield national blood product inventory from strain during pandemic-induced activation of the National Plan for the Management of Shortages of Labile Blood Components. La nouvelle maladie à coronavirus pandémique (COVID-19) peut se compliquer d’un syndrome de détresse respiratoire aiguë (SDRA) grave. Dans un tel cas, l’assistance vitale extracorporelle constitue la dernière stratégie de secours possible. Les divergences dans les pratiques, combinées à un manque de lignes directrices rigoureuses, peuvent compliquer l’accessibilité et la répartition des ressources relatives aux produits sanguins en situation de pandémie. Nous avons passé en revue les publications s’intéressant aux pratiques en matière de transfusion de plaquettes, de concentré de globules rouges, de plasma frais congelé, de concentré de complexe prothrombinique et d’antithrombine à des patients sous oxygénation par membrane extracorporelle (ECMO pour extracorporeal membrane oxygenation) veinoveineuse. Nous avons notamment examiné les lignes directrices pertinentes de différentes associations et analysé la situation à partir d’un échantillon des pratiques adoptées par des spécialistes canadiens en assistance vitale extracorporelle. L’article qui suit constitue une synthèse de ces examens et des commentaires recueillis auprès de la Société canadienne pour les soins intensifs cardiovasculaires, de
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2020.06.014