Red blood cell transfusion in veno-arterial extracorporeal membrane oxygenation - the disconnect between oxygen delivery and tissue oxygenation.

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2025-04-22 DOI:10.1177/02676591241239569

Sophie H Fincher, Warwick Butt

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Abstract

BackgroundRed cell transufion in veno-arterial membrane oxygenation (VA ECMO) has been widely debated.PurposeThis narrative review aims to examine the historical and current approaches of red cell transfusion in veno-arterial extracorporeal membrane oxygenation (VA ECMO) to enhance oxygen delivery. It will explore the potential benefits and pitfalls of red blood cell (RBC) transfusion in VA ECMO, including relationship between haemoglobin (Hb) concentration, tissue oxygenation and patient outcomes associated with transfusion. Following it will review the impact of cardiogenic shock on the microcirculation, performance of transfused RBC and effects of the ECMO circuit on RBC function. It will conclude with an introduction to potential mechanisms by which we might manipulate red cells to improve tissue oxygenation, without augmentation of Hb concentration.ConclusionFurther research is needed to provide insight into optimal RBC transfusion thresholds and strategies to augment red cell function to optimise tissue oxygenation in VA ECMO.

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静脉-动脉体外膜氧合中的红细胞输注-氧输送和组织氧合之间的脱节。

静脉-动脉膜氧合（VA ECMO）中的红细胞输注一直存在广泛的争议。目的：本综述旨在回顾静脉-动脉体外膜氧合（VA ECMO）中红细胞输注以增强氧输送的历史和当前方法。该研究将探讨VA ECMO中红细胞（RBC）输血的潜在益处和缺陷，包括血红蛋白（Hb）浓度、组织氧合和输血相关患者结局之间的关系。接下来将回顾心源性休克对微循环的影响，输血红细胞的性能以及ECMO回路对红细胞功能的影响。最后将介绍潜在的机制，我们可能操纵红细胞，以改善组织氧合，而不增加血红蛋白浓度。结论需要进一步的研究来提供最佳的红细胞输血阈值和增强红细胞功能以优化VA ECMO组织氧合的策略。

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来源期刊

Perfusion-Uk 医学-外周血管病

CiteScore

3.00

自引率

8.30%

发文量

203

审稿时长

6-12 weeks

期刊介绍： Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.