TY - JOUR
T1 - Transfusion of red blood cells in venoarterial extracorporeal membrane oxygenation
T2 - A multicenter retrospective observational cohort study
AU - Raasveld, Senta Jorinde
AU - Karami, Mina
AU - Schenk, Jimmy
AU - Dos Reis Miranda, Dinis
AU - Mandigers, Loes
AU - Dauwe, Dieter F
AU - De Troy, Erwin
AU - Pappalardo, Federico
AU - Fominskiy, Evgeny
AU - van den Bergh, Walter M
AU - Oude Lansink-Hartgring, Annemieke
AU - van der Velde, Franciska
AU - Maas, Jacinta J
AU - van de Berg, Pablo
AU - de Haan, Maarten
AU - Donker, Dirk W
AU - Meuwese, Christiaan L
AU - Taccone, Fabio Silvio
AU - Peluso, Lorenzo
AU - Lorusso, Roberto
AU - Delnoij, Thijs S R
AU - Scholten, Erik
AU - Overmars, Martijn
AU - Ivancan, Višnja
AU - Bojcic, Robert
AU - de Metz, Jesse
AU - van den Bogaard, Bas
AU - de Bakker, Martin
AU - Reddi, Benjamin
AU - Hermans, Greet
AU - Broman, Lars Mikael
AU - Henriques, José P S
AU - Vlaar, Alexander P J
PY - 2023/10
Y1 - 2023/10
N2 - BACKGROUND: Evidence-based recommendations for transfusion in patients with venoarterial extracorporeal membrane oxygenation (VA ECMO) are scarce. The current literature is limited to single-center studies with small sample sizes, therefore complicating generalizability. This study aims to create an overview of red blood cell (RBC) transfusion in VA ECMO patients. METHODS: This international mixed-method study combined a survey with a retrospective observational study in 16 centers. The survey inventoried local transfusion guidelines. Additionally, retrospective data of all adult patients with a VA ECMO run >24?h (January 2018 until July 2019) was collected of patient, ECMO, outcome, and daily transfusion parameters. All patients that received VA ECMO for primary cardiac support were included, including surgical (i.e., post-cardiotomy) and non-surgical (i.e., myocardial infarction) indications. The primary outcome was the number of RBC transfusions per day and in total. Univariable logistic regressions and a generalized linear mixed model (GLMM) were performed to assess factors associated with RBC transfusion. RESULTS: Out of 419 patients, 374 (89%) received one or more RBC transfusions. During a median ECMO run of 5?days (1st-3rd quartile 3-8), patients received a median total of eight RBC units (1st-3rd quartile 3-17). A lower hemoglobin (Hb) prior to ECMO, longer ECMO-run duration, and hemorrhage were associated with RBC transfusion. After correcting for duration and hemorrhage using a GLMM, a different transfusion trend was found among the regimens. No unadjusted differences were found in overall survival between either transfusion status or the different regimens, which remained after adjustment for potential confounders. CONCLUSION: RBC transfusion in patients on VA ECMO is very common. The sum of RBC transfusions increases rapidly after ECMO initiation, and is dependent on the Hb threshold applied. This study supports the rationale for prospective studies focusing on indications and thresholds for RBC transfusion.
AB - BACKGROUND: Evidence-based recommendations for transfusion in patients with venoarterial extracorporeal membrane oxygenation (VA ECMO) are scarce. The current literature is limited to single-center studies with small sample sizes, therefore complicating generalizability. This study aims to create an overview of red blood cell (RBC) transfusion in VA ECMO patients. METHODS: This international mixed-method study combined a survey with a retrospective observational study in 16 centers. The survey inventoried local transfusion guidelines. Additionally, retrospective data of all adult patients with a VA ECMO run >24?h (January 2018 until July 2019) was collected of patient, ECMO, outcome, and daily transfusion parameters. All patients that received VA ECMO for primary cardiac support were included, including surgical (i.e., post-cardiotomy) and non-surgical (i.e., myocardial infarction) indications. The primary outcome was the number of RBC transfusions per day and in total. Univariable logistic regressions and a generalized linear mixed model (GLMM) were performed to assess factors associated with RBC transfusion. RESULTS: Out of 419 patients, 374 (89%) received one or more RBC transfusions. During a median ECMO run of 5?days (1st-3rd quartile 3-8), patients received a median total of eight RBC units (1st-3rd quartile 3-17). A lower hemoglobin (Hb) prior to ECMO, longer ECMO-run duration, and hemorrhage were associated with RBC transfusion. After correcting for duration and hemorrhage using a GLMM, a different transfusion trend was found among the regimens. No unadjusted differences were found in overall survival between either transfusion status or the different regimens, which remained after adjustment for potential confounders. CONCLUSION: RBC transfusion in patients on VA ECMO is very common. The sum of RBC transfusions increases rapidly after ECMO initiation, and is dependent on the Hb threshold applied. This study supports the rationale for prospective studies focusing on indications and thresholds for RBC transfusion.
KW - RBC transfusion
KW - blood management
KW - transfusion practices (adult)
U2 - 10.1111/trf.17505
DO - 10.1111/trf.17505
M3 - Article
SN - 0041-1132
VL - 63
SP - 1809
EP - 1820
JO - Transfusion
JF - Transfusion
IS - 10
ER -