{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T21:23:29Z","timestamp":1776288209398,"version":"3.50.1"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:00:00Z","timestamp":1759622400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Extracorporeal membrane oxygenation (ECMO) is a last resort treatment for children with cardio\u2010respiratory failure. Some of these patients will develop thrombocytopenia\u2010associated multiple organ failure (TAMOF), which is sometimes managed with therapeutic plasma exchange (TPE). Our objective is to describe critically ill children on ECMO who underwent TPE for TAMOF. We conducted a single\u2010center retrospective case series of seven children with congenital cardiac disease, requiring ECMO, diagnosed with TAMOF, and treated with TPE between 12\/2023 and 6\/2024. A centrifugation\u2010based apheresis instrument was used to process 1.5 total blood volume. One packed red blood cell was used to prime the apheresis circuit. Systemic bivalirudin was used for anticoagulation. Seven patients (median age: 55\u2009days, median weight: 4.0\u2009kg, median bypass time: 172\u2009min, 100% VA ECMO, 85% central cannulation, 100% bivalirudin) underwent a total of 30 TPE sessions. The median number of sessions per patient was 3, with a median time to first session of 27.3\u2009h after cannulation. Plasma was used as the replacement fluid in all sessions, with a median volume of 168\u2009mL\/kg. The median platelet count increased from 45\u2009\u00d7\u200910\n                    <jats:sup>9<\/jats:sup>\n                    \/L (38; 54) pre\u2010TPE to 64 (IQR: 45; 75,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) post\u2010TPE, despite no platelet transfusions during TPE. The modified organ severity index decreased significantly from 13 to 12 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). The mortality rate was 71%. TPE may improve platelet counts and reduce organ severity scores in critically ill children with TAMOF on ECMO.\n                  <\/jats:p>","DOI":"10.1002\/jca.70061","type":"journal-article","created":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T16:59:54Z","timestamp":1759683594000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Plasma Exchange in the Setting of Immune\u2010Mediated Multiple Organ Failure in the Cardiac\n                    <scp>ICU<\/scp>\n                    During\n                    <scp>ECMO<\/scp>\n                    : A Case Series"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7234-705X","authenticated-orcid":false,"given":"Sonia","family":"Labarinas","sequence":"first","affiliation":[{"name":"Children's Heart Institute, Pediatric Cardiac Critical Care, Advanced Cardiopulmonary Therapies and Transplantation University of Texas\u2010Health Science Center at Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalpana","family":"Norbisrath","sequence":"additional","affiliation":[{"name":"Children's Heart Institute, Pediatric Cardiac Critical Care, Advanced Cardiopulmonary Therapies and Transplantation University of Texas\u2010Health Science Center at Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibeh","family":"Nnaemeka","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, McGovern Medical School The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, McGovern Medical School The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hlaing","family":"Tint","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, McGovern Medical School The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Johnson","sequence":"additional","affiliation":[{"name":"Children's Heart Institute, Pediatric Cardiac Critical Care, Advanced Cardiopulmonary Therapies and Transplantation University of Texas\u2010Health Science Center at Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Brady","sequence":"additional","affiliation":[{"name":"Children's Heart Institute, Pediatric Cardiac Critical Care, Advanced Cardiopulmonary Therapies and Transplantation University of Texas\u2010Health Science Center at Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6606-1736","authenticated-orcid":false,"given":"Oliver","family":"Karam","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care, Department of Pediatrics Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,5]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"ELSO \u201cECLS International Summary of Statistics \u201d2023 https:\/\/www.elso.org\/registry\/internationalsummaryandreports\/internationalsummary.aspx."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002105"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000240243.28129.36"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-021-01622-8"},{"issue":"15","key":"e_1_2_8_6_1","first-page":"779","article-title":"Hepatic Dysfunction Following Cardiac Surgery: Determinants and Consequences","volume":"44","author":"Michalopoulos A.","year":"1997","journal-title":"Hepato\u2010Gastroenterology"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/14017438409109894"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2018.09.017"},{"key":"e_1_2_8_9_1","first-page":"1","article-title":"Thrombocytopenia Related to Multiple Organ Failure (TAMOF) Related to Extracorporeal Circulation in Cardiac Surgery in Paediatrics","volume":"5","author":"Vera E. F.","year":"2020","journal-title":"Pediatric Dimensions"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.113.6.1625"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000227"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.4103\/0973-6247.150936"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000351"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181e30d09"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2017.00254"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2020.01.054"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70061","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T05:51:38Z","timestamp":1764395498000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.70061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/jca.70061"],"URL":"https:\/\/doi.org\/10.1002\/jca.70061","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"value":"0733-2459","type":"print"},{"value":"1098-1101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-03-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70061"}}