How we Provide Transfusion Support for Neonatal and Pediatric Patients on Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) provides lifesaving
hemodynamic and respiratory support to neonatal and pediatric patients
with a variety of congenital or acquired cardiopulmonary defects.
Successful ECMO support requires close collaboration among multiple
services, including critical care medicine, perfusion, and transfusion
medicine services. Neonatal and pediatric ECMO patients require
significant transfusion support, both at the time of cannulation and
after the ECMO circuit has been established, often with little advance
notice. Thus a number of communication and logistic issues must be
addressed through a multidisciplinary approach to ensure both good
patient outcome and judicious use of resources. In this article, we
describe our protocol for transfusion support for ECMO and potential
ECMO patients, which was developed to address a number of issues,
including identifying and stratifiying ECMO candidate patients,
streamlining the ordering and communication processes, and improving
blood product turnaround times and availability. Additional measures of
quality improvement are also discussed. As the number of centers
performing ECMO procedures remains high, we believe that our experience
may be of interest to our colleagues in transfusion medicine and
critical care.