Does anyone have a protocol for use of ECMO in adult patients? What products and how many are used for priming the circuit? Do you send blood up in a cooler when the patient is first put on ECMO? Any info would be helpful. Thanks.

I'm not sure if you have gotten the information you need but our facility does ECMO (often) on all size patients. We have had babies that weighed < a kilogram up to the 35 yr old man that was 6'2" and weighed 265 lbs. We currently have monitered refrigerators in all the units that do ECMO but before those were in place we sent a bedside blood box with the initial red cell units and then maintained it at the bedside with 1-2 maintenance units in case of emergency (membrane rupture or accidental decanulation). We moitered the temp and changed the ice every eight hours. As to how much blood is needed to prime the circuit it depends again on the patient's size for adults they generally use 3-4 units and they generally give 1 platelet pheresis.

We also have patient's of all ages on ECMO, even a couple of H1N1 patients this fall. Prime blood is based on weight:

1-10kg: 3 CPD rbc and 1 plasma

11-30kg: 3 CPD rbc and 2 plasma

>30kg (including adults): 2 CPD and 2 Adsol rbc and 2 plasma

All prime blood is less than 7 days old, Sickle negative, Leukoreduced. You may find some institutions that also irradiate blood for ECMO, but currently we do not. We keep at least 4 units of fresh CPD ready to go for an emergent ECMO prime on hand at all times. The prime blood is issued all at once and placed in a cooler for transport only. By this time, it is almost NEVER returned, as the ECMO team is ready to go by the time they pick up the blood products.

Once the patient is on ECMO, extra blood is crossmatched for maintenance as ordered by the physician. These units are adsol rbc, less than 7 days old and also sickle neg, LR. We also ensure adequate platelets are available if needed. All blood is kept in the Transfusion Service until ordered/requested by the clinicians. We can send blood up to the floors via the pneumatic tube system, so maintenance blood products can be sent relatively quickly.

Stephanie Townsend, MT(ASCP)SBB

Thank you both so much for your responses! PAWHITECAR, do you also use CPD units?

This may cross into the "Just for Fun" thread, but when our Distribution department manager was new (to our facility and to blood banking in general), she received a call from a hospital needing fresh O negs STAT for an ECMO baby. She was very curious as to what could so special about an Eskimo baby...

LOVE IT!

That has brightened my day.

:D:D:D:D