The purpose of this study is to assess the impact of scheduled fresh frozen plasma (FFP) administration on extracorporeal membrane oxygenation (ECMO) pump longevity in critically ill pediatric and neonatal patients. Almost all ECMO patients receive multiple FFP transfusions during their ECMO course. The investigator proposes that scheduled FFP may maintain pro and anticoagulation balance thus mitigating the need for expensive and dangerous ECMO pump changes. In addition, this may lead to less overall transfusion with all products (red blood cells, platelets, and FFP) if coagulation homeostasis is maintained. The subjects will be neonatal and pediatric patients requiring ECMO support for any reason in the pediatric and pediatric cardiac critical care units. Subjects will be randomized to receive every other day FFP infusions or FFP administration per current standard of care. ECMO pump longevity (hours) and FFP use will be compared between the two groups There is a small risk that study subjects may receive more FFP transfusions and therefore have the increased associated risks however it is also possible that these subjects may benefit from less ECMO circuit changes and/or fewer transfusions of all blood products.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
31
Fresh frozen plasma is a pooled blood product containing both pro and anticoagulation factors. Patients enrolled in the intervention arm will receive scheduled fresh frozen plasma treatment every 48 hours. Patients in the control arm will receive fresh frozen plasma per current institutional standard of care. This includes supplementation for clotting/bleeding diatheses, volume replacement, or after 3 red blood cell transfusions in a 24 hour period.
Duke University Medical Center PICU and PCICU
Durham, North Carolina, United States
ECMO Pump Longevity
The primary endpoint is the ECMO pump longevity (measured in hours). The life of the circuit was defined as start of that circuit to circuit change or decannulation from ECMO for each patient. Circuit life was measured in hours
Time frame: ECMO course (median 198 hours)
Hemorrhagic and Thrombotic Complications
Complications associated with coagulation in both the patient and the pump will be collected.
Time frame: ECMO course (median 198 hours)
Antithrombin Levels
Compared antithrombin levels in neonates in control versus treatment group
Time frame: ECMO course (median 198 hours)
Plasma Free Hemoglobin
Compare plasma free hemoglobin levels between control and treatment group
Time frame: ECMO course (median 198 hours)
Red Blood Cell Transfusion
Compared red blood cell transfusion during ECMO for control versus treatment group
Time frame: ECMO course (median 198 hours)
Time to Therapeutic aPTT
Compared time in hours to goal aPTT for control versus treatment group
Time frame: ECMO course (median 198 hours)
Platelets Transfusion Requirement
Compared platelet transfusion during ECMO for control versus treatment group
Time frame: ECMO course (median 198 hours)
Fresh Frozen Plasma Transfusion Requirements
Compared fresh frozen plasma transfusion during ECMO for control versus treatment group
Time frame: ECMO course (median 198 hours)
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