Restrictive Platelet Transfusion During Pediatric ECMO

Tuesday, March 24, 2026

12:30 PM - 1:30 PM Central Time

Location: Connections Central - RST 07

KN

Kristen Nelson McMillan, MD

Disclosure(s): No relevant financial relationship(s) to disclose.
DW

Diane Ward, RN, BSN

Lead, Pediatric Pulmonary HTN nurse
Advocate Children's Heart Institute, Indiana

Disclosure information not submitted.
MA

Mervat Abdel-Jawad, MS, RRT, CES-P

ECMO Coordinator
Advocate Children's Hospital, Indiana

Disclosure information not submitted.
Alexis Miles, PA-C (she/her/hers)

Advocate Children's Hospital, Illinois

Disclosure(s): No relevant financial relationship(s) to disclose.
AP

Andrea Pelock, BS, MT (ASCP)

Transfusion Services Supervisor
Advocate Children's Hospital, Advocate Christ Medical Center

Disclosure information not submitted.
CA

Colleen Aronson, BS, MLS (ASCP) SBB

Technical Director, Transfusion Services
Advocate Children's Hospital, Advocate Christ Medical Center

Disclosure information not submitted.
BB

Bryanna Biszewski, RN, BSN

Pediatric pulmonary hypertension, RN
Advocate Children's Heart Institute, Indiana

Disclosure information not submitted.
MH

Mohammed Hamzah, MD

Pediatric cardiac critical care attending
Advocate Children's Heart Institute

Disclosure information not submitted.
LV

Luca A. Vricella, MD

Director, Pediatric Cardiac Surgery
Advocate Children's Heart Institute, Illinois

Disclosure information not submitted.
CU

Cynthia Urbas, CCP, LP, FPP

Chief, Pediatric Perfusionist
Advocate Children's Heart Institute, Indiana

Disclosure information not submitted.

Introduction: Platelet transfusion during pediatric ECMO is frequent, with recent literature reporting averages up to 12 ml/kg/day of platelets, with >50% reported as prophylactic transfusions. Platelet goals of >100,000/mL are common to prevent or treat bleeding, but there remains a lack of evidence to support these recommendations. We aimed to assess if a restrictive platelet transfusion threshold could be implemented without increasing bleeding in a pediatric ECMO population.

Methods: We conducted a retrospective review of pediatric ECMO cases from January 1 to December 31, 2024, at a tertiary care children’s hospital. Transfusions administered during ECMO and hematologic labs were analyzed with review of blood bank records and chart review.

Results: There were 36 ECMO runs for 32 unique patients, with one patient converted to a right ventricular assist device with an oxygenator (oxyRVAD). Mean age was 4.7 years (range: 0 days to 61 years). Mean ECMO duration was 16.8 days (range: 1-165 days), Congenital heart disease was the most common diagnosis (24/32, 75%), with 63% of patients requiring cardiac surgery within 1 week prior to or during their ECMO run. Mean volume of platelet transfusions was 2.3 ml/kg/day. Of 589 ECMO days for this cohort, platelet transfusions only occurred on 10% (61/589) of total days, with one patient requiring 28% of those transfusions. Of patients receiving platelets, 50% (12/24) received only one transfusion. Most common threshold for platelet transfusion was < 30,000/mL, guided by institutional ECMO recommendations with use of rotational thromboelastometry to assess platelet function and clinical concern for bleeding. 33% (12/36) of ECMO runs in this cohort received no platelet transfusion. Survival to ECMO decannulation was 75% for the overall cohort. Packed red blood cell transfusions averaged 10.3 ml/kg/day, compared to >20 ml/kg/day with non-restrictive platelet goals. There were no brain hemorrhages or hemorrhagic strokes in this cohort.

Conclusions: Restrictive platelet transfusion thresholds were safe in this cohort and may influence decisions to transfuse blood products in general. Tailoring platelet transfusions to patient-specific goals as opposed to an absolute number may decrease transfusion exposures and adverse complications without increasing bleeding risk.