Platelet Phenotype and Function Changes With Increasing Duration of Extracorporeal Membrane Oxygenation.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 08 2022
01 08 2022
Historique:
pubmed:
13
1
2022
medline:
19
7
2022
entrez:
12
1
2022
Statut:
ppublish
Résumé
To investigate platelet pathophysiology associated with pediatric extracorporeal membrane oxygenation (ECMO). Prospective observational study of neonatal and pediatric ECMO patients from September 1, 2016, to December 31, 2019. The PICU in a large tertiary referral pediatric ECMO center. Eighty-seven neonates and children (< 18 yr) supported by ECMO. None. Arterial blood samples were collected on days 1, 2, and 5 of ECMO and were analyzed by whole blood flow cytometry. Corresponding clinical data for each patient was also recorded. A total of 87 patients were recruited (median age, 65 d; interquartile range [IQR], 7 d to 4 yr). The median duration of ECMO was 5 days (IQR, 3-8 d) with a median length of stay in PICU and hospital of 18 days (IQR, 10-29 d) and 35 days (IQR, 19-75 d), respectively. Forty-two patients (48%) had at least one major bleed according to a priori determined definitions, and 12 patients (14%) had at least one thrombotic event during ECMO. Platelet fibrinogen receptor expression decreased (median fluorescence intensity [MFI], 29,256 vs 26,544; p = 0.0005), while von Willebrand Factor expression increased (MFI: 7,620 vs 8,829; p = 0.0459) from day 2 to day 5 of ECMO. Platelet response to agonist, Thrombin Receptor Activator Peptide 6, also decreased from day 2 to day 5 of ECMO, as measured by binding with anti-P-selectin, PAC-1 (binds activated GPIIb/IIIa), and anti-CD63 monoclonal antibodies (P-selectin area under the curve [AUC]: 63.46 vs 42.82, respectively, p = 0.0022; PAC-1 AUC: 93.75 vs 74.46, p = 0.0191; CD63 AUC: 55.69 vs 41.76, p = 0.0020). The loss of platelet response over time may contribute to bleeding during ECMO. These novel insights may be useful in understanding mechanisms of bleeding in pediatric ECMO and monitoring platelet markers clinically could allow for prediction or early detection of bleeding and thrombosis.
Identifiants
pubmed: 35020670
doi: 10.1097/CCM.0000000000005435
pii: 00003246-202208000-00006
doi:
Substances chimiques
Selectins
0
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1236-1245Informations de copyright
Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. d’Udekem’s institution received funding from Actelion (Janssen) and from Berlin Heart. Drs. Ignjatovic’s and Mongale’s institutions received funding from the National Health and Medical Research Council (grant APP1129317). The remaining authors have disclosed that they do not have any potential conflicts of interest.
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