ECMO Center transfusion protocol

[martha]

We are a children hospital with an ECMO Center and I am trying to change our transfusion protocol. I will like to know what are other ECMO centers doing. Does any one wash RBC to start the ECMO circuit? What is the tranfusion protocol specially to start the circuit?

Thank You,

Martha

[KECIA]

We are a children hospital with an ECMO Center and I am trying to change our transfusion protocol. I will like to know what are other ECMO centers doing. Does any one wash RBC to start the ECMO circuit? What is the tranfusion protocol specially to start the circuit?

Thank You,

Martha

Hi Martha I also work at a childrens hospital an the way ecmo works here:

1. if we know the infants type they get type-specific prbc(leuko-irr)< or = to 7 days for VA ecmo. If its VV they may asked for washed but its not required.

2. the infant is an HDN then its Ocells same protocal (unwashed).

3. If the type is unknown then they get Onegs. We only wash if the blood upon start up is not < or = to 7 days. CICU patients will always get prbcs < or = to days or washed. Booster transfusions are any age prbs. Any more questions you can email me @ smithke@email.chop.edu.

[skusic]

Hi Martha I also work at a childrens hospital an the way ecmo works here:

1. if we know the infants type they get type-specific prbc(leuko-irr)< or = to 7 days for VA ecmo. If its VV they may asked for washed but its not required.

2. the infant is an HDN then its Ocells same protocal (unwashed).

3. If the type is unknown then they get Onegs. We only wash if the blood upon start up is not < or = to 7 days. CICU patients will always get prbcs < or = to days or washed. Booster transfusions are any age prbs. Any more questions you can email me @ smithke@email.chop.edu.

Hello. I would like to ask what is the preservative solution in the blood that you use for the neonates?

[martha]

Hello. I would like to ask what is the preservative solution in the blood that you use for the neonates?

We use Adsol or CPDA for many years with no problems.

[KECIA]

I also work at a children's hospital and what we do for ECMO is upon the circuit start-up we provide leukoreduced packed cells that are 7 days or less( we term them as fresh). If we do not have fresh cells then we would wash. For booster transfusion there is no requirement. Our cardiac patient always received fresh red cells, so for them its either fresh or washed while on ECMO. We do have to types of ECMO VA and VV. VV they may request for wahed cells but they.

[martha]

Kesia,

Thank You for respond. We use washed cells on all ECMOs and I am trying to change to fresh RBC and avoid the washing, which delays the procedure or are wasted if the patient is not put in ECMO.

I have another issue How do you store the blood for OR? Do you have coolers ? What is your process to issue /store products for the OR?

We have a small refrigerator in the OR which the temperature is monitor 24/7 , and the alarmi s tested Quarterly. The blood is issued each morning and stored until each case. I just had an AABB inspection and the assesor feels that it is a high risk for mistransfusion. The transfusion service is not close to the OR and in case of emergency there is not enough time to come and pick up the units. Any ideas?

Happy Holidays !

Martha Delgado:cries:

[Debbie]

You stated that you use Adsol or CPD-A. Have you ever used AS-3? (I think it's called Optisol or something)

Is there a concern about fluid overload with additive units rather than CPD-A?

[mobea]

Hi

I'm at a Childrens Hospital also. For ECMO we are providing blood <7 days old, or washed if < 7 day is not available.

As for blood to OR, we did away with the refrigerator in the OR a few years back. (There was a Joint Commission Sentinel event alert published August 1999 identifying the practice of storing multiple patients blood in OR refrigerators as a source of error. The interpretation was "JC does not approve of this method"). We now issue patient specific coolers to each OR case, these are picked up before the start of the case and delivered to the OR room.

[martha]

You stated that you use Adsol or CPD-A. Have you ever used AS-3? (I think it's called Optisol or something)

Is there a concern about fluid overload with additive units rather than CPD-A?

Hi Debbie,

Yes we had used AS-3 rarely without problems.

[bloodpumper]

I'm not going to comment specifically on any protocol, but on the concept of washing stored, preservative red cells. All of these products are very acidic and have very high glucose loads. Both of which are detrimental to neonates and peds on ECMO. I am also assuming that fresh leukoreduced or less than seven day old blood is used. Stored blood has time dependent storage lesions that can harm the microcirculation and lungs. Acidity can be corrected with bicarb, but then you are adding a high sodium load to the ECMO prime. Again, not good for this patient population. Don't always think about THAM, tromethamine, it's contraindicated in uremia and anuria. In neonates it is also contraindicated in chronic respiratory acidosis and salicylate intoxication. It can cause a high water load if the kidneys aren't working well. The best method to remove the acidity and glucose in stored preservative red cells is to wash in a cell washing device with a balanced electrolyte solution. You will get a more physiologic product that will not require too much manipulation or cause too much patient harm. Consult with the physicians and perfusionists before considering any changes to a specialty that they are the medical experts in.

Mark Lucas, MPS, CCP

Blood Management Consultant

[Mer]

Hi - For all ECMO patients, we use the freshest blood - for infants we spin a "prime" unit down and take the Adsol off, and then we set up one full unit and a partial (1/2) unit of RBC's. Then we set up 1 random platelet and 1 FFP.

For adults we set up 2 FFPs, 9 RBC's (none spun down), and any platelets requested.

We were just informed a few weeks ago that we no longer have to do the prime unit for infants, so now we just set up 2 1/2 units of RBC's (much easier).

Mer