(P-TS-25) Coagulopathy as a Predictor of Mortality in Pediatric ECMO: Survival Analysis and Blood Component Use

Extracorporeal membrane oxygenation (ECMO) is a life-saving procedure for managing severe cardiac and respiratory conditions requiring careful transfusion support. This study aimed to analyze mortality in pediatric patients undergoing ECMO therapy and its association with using blood components.

Study

Design/Methods:

A retrospective cohort study was conducted using records from pediatric patients (ages 0-84 months) treated between January and December 2023 at a center located at an intermediate altitude (2600 m). Socio-demographic and clinical variables, in-hospital mortality outcomes, duration of ECMO therapy, and use of blood components were analyzed. A bivariate analysis of the mortality outcome regarding clinical and socio-demographic variables was performed. Proportions were compared using the chi-square test. Normality for quantitative variables, the Shapiro-Wilk, Student's T-test, or Mann-Whitney test were used. Survival analysis was conducted using the Kaplan-Meier method based on the duration of ECMO therapy, adjusted for variables that showed an association with mortality in the bivariate analysis, employing the post-hoc Log-Rank test. A significance level was set at p< 0.05. Statistical analysis was performed using IBM SPSS v29 and Stata v18.

Results/Findings:

Records of 48 patients were analyzed, of which 69% were 0-11 months old, and 31% were 12-84 months old. The overall mortality rate was 39.6%, and the average duration of ECMO therapy was 25±39 days. Mortality was higher among patients with congenital malformations (diaphragmatic hernia, esophageal atresia, atrial septal defect, aortic coarctation) and lower among those with viral respiratory infections. An association was found between mortality and higher INR and lower fibrinogen levels at the start of ECMO therapy, as well as greater use of red blood cells, platelets, fresh frozen plasma, and the total number of components transfused. No association was observed with age, sex, hemoglobin levels, or use of cryoprecipitates. Survival analyses showed that patients with congenital malformations had a median survival of 16 days, those with bacterial respiratory infections 55 days, with viral respiratory infections 70 days, and with primary pulmonary hypertension 108 days; patients whose initial INR was greater than 2.0 had a median survival of 8 days compared to those with an INR of 0.8-2.0 (70 days, p=0.016); patients with initial fibrinogen levels lower than 110 mg/dL had a median survival of 17 days compared to the overall median of 55 days (p=0.046)(Figure1).

Conclusions:

In a cohort of 48 pediatric patients (0-84 months) on ECMO therapy, the overall mortality rate was 39.6%, associated with the primary diagnosis and greater use of blood components (red blood cells, platelets, and fresh frozen plasma). The survival analyses showed that both the primary diagnosis and coagulopathy at the start of ECMO therapy are predictors of mortality.