Pediatric anesthesia & critical care
Platelet Transfusion Thresholds for Children Supported by Extracorporeal Membrane Oxygenation: The Extracorporeal Membrane Oxygenation Hemostatic Transfusions in Children (ECSTATIC) Feasibility Clinical Trial
Primary result · Pre-transfusion platelet countResult — go to the resultModel-adjusted mean difference 32 × 10 9 /LAuthors' conclusion
Non-bleeding children on ECMO can be screened, enrolled and randomized to different platelet transfusion strategies within 24 hours of cannulation. Compliance with the protocol was excellent with significant separation in pre-transfusion platelet counts between the arms. Severe bleeding and severe clotting occurred at similar rates in both thresholds.
Study context
- Population
- Critically ill children (0 to <18 yr) on extracorporeal membrane oxygenation (ECMO) with no or minimal bleeding within 24 hours of cannulation; 10 ECMO centres (9 US, 1 Israel)123/159 screened eligible
- Participants
- 50 children
- Comparison
- Higher vs lower prophylactic platelet transfusion threshold
- Primary endpoint
- Feasibility: pre-transfusion platelet count (difference between strategies); safety: progression to severe bleeding, severe clotting and/or all-cause mortality
Methodological detailsfeasibility, multicentre
- Feasibility
- Multicentre
Primary result
Pre-transfusion platelet count
Model-adjusted mean difference
32 × 10 9 /L
P < 0.001
As reported in the abstract
- Compliance with assigned transfusion threshold
- 99.2%
Further findings
Recruitment feasibility
- Caregivers approached for consent
- 65% (80/123)
- Consent obtained
- 63% (50/80)
Safety
Primary safety outcome (severe bleeding, severe clotting and/or all-cause mortality), all children
- Children with primary safety outcome
- 11 (22%)
- Progression to severe bleeding
- 14% (7/50)
- Progression to severe clotting
- 4% (2/50)
- Severe bleeding and severe clotting at similar rates in both thresholds
Original publication
Platelet Transfusion Thresholds for Children Supported by Extracorporeal Membrane Oxygenation: The Extracorporeal Membrane Oxygenation Hemostatic Transfusions in Children (ECSTATIC) Feasibility Clinical Trial. Crit Care Med. Published 23 December 2025. doi:10.
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