This article was originally posted in the Yale Medicine Newsroom.
In a first of its kind pilot study, Oliver Karam, MD, PhD, chief of pediatric critical care at Yale School of Medicine, and Marianne Nellis, MD, MS, associate professor in pediatric critical care at Weill Cornell Medicine, have been funded by the National Institutes of Health (NIH) to study different platelet transfusion thresholds for children supported by ECMO machines (extracorporeal membrane oxygenation). The ECmo hemoSTAtic Transfusions In Children (ECSTATIC) pilot trial will test two different platelet transfusion strategies, based on two different platelet count thresholds in critically ill infants and children.
Patients have received blood transfusions since as far back as 1820 but they became more widely used on the battlefield during World War I. Ever since, people have been giving and receiving blood, but there are relatively few studies to help doctors determine when and how blood products may be used most effectively.
When patients are on ECMO, all their blood passes through the machine and is pumped back into the circulatory system in order to support the heart and lungs. Because of this process, there is high risk of both bleeding and clotting. Over the last 40-50 years, experts have tended to keep platelet counts high to avoid excessive bleeding – but it is not understood if this is the right thing to do and where the proper platelet threshold lies. Mounting evidence has demonstrated significant morbidity and mortality associated with these transfusions. The study led by Karam and Nellis is the first in the world to help determine whether a low or high platelet count is safer for children on ECMO.
We are now going to see if the current, higher values, keeping a patient at 90,000 platelets for example, is the right thing. If it is, that’s fine, now we know. Or can we go lower and improve care?
Oliver Karam, MD, PhD
Platelets themselves are also a scarce resource. Patients supported by ECMO are huge consumers of platelet transfusions, which may be difficult to acquire and must be donated by people at transfusion centers or blood drives. The study will help determine the possibility of using platelets in lower quantities to improve efficiency of use. Karam explains, “We are now going to see if the current, higher values, keeping a patient at 90,000 platelets for example, is the right thing. If it is, that’s fine, now we know. Or can we go lower and improve care?”
Fewer than 1,000 pediatricians, out of about 125,000, have received NIH awards nationwide. The pilot study will take place over three years. More details of the study and the award can be found here.
To volunteer to donate blood or platelets for all kinds of patients in need, please look up a drive and schedule a donation in your area.