Red blood cell transfusion practices in extracorporeal membrane oxygenation: A single-center study.

IF 1.5 4区医学 Q3 HEMATOLOGY

Transfusion Medicine Pub Date : 2025-07-04 DOI:10.1111/tme.13154

Shailesh Balasubramanian, Mahmoud Alwakeel, Divyajot Sadana, Mani Latifi, Chase Donaldson, Brett Wakefield, Edward Soltesz, Kenneth McCurry, Sudhir Krishnan

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引用次数: 0

Abstract

Objectives: Evaluating blood transfusion practices and their impact on morbidity and mortality across extracorporeal membrane oxygenation (ECMO) configurations.

Background: As ECMO becomes increasingly utilised in critical care, the ideal Hgb level remains uncertain. While guidelines recommend higher levels, emerging evidence suggests potential harm. Our study addresses this gap by investigating the optimal Hgb level for ECMO.

Methods: A retrospective cohort study included all adult patients receiving ECMO between January 2016 and December 2018. The primary outcome assessed the optimal Hgb level associated with reduced ECMO duration and in-hospital mortality. Multivariable and Cox-proportional regression analyses were performed.

Results: A total of 306 patients underwent ECMO, with 31 patients having mean Hgb levels 7-7.9 g/dL, 176 patients 8-8.9 g/dL, 72 patients 9-9.9 g/dL, and 27 patients ≥10 g/dL. The mean (SD) age was 56 years (15), with 60.8% male (186/306). ECMO configurations were primarily Venoarterial (VA) (59.8%), followed by Venovenous (VV) (36.9%) and Hybrid (3.3%). The 7-7.9 g/dL Hgb group was associated with longer ECMO duration (mean 17.5 days, coefficient 2.2, 95% CI 0.02-4.4, p = 0.048) compared to the ≥10 g/dL group, with no significant mortality differences across Hgb levels. VA ECMO patients had a significantly higher mortality risk than VV ECMO patients (aHR 2.33, 95% CI 1.50-3.60, p < 0.001). Blood product use, including RBC and Cryo, was associated with longer ECMO duration, while FFP reduced both duration (coefficient - 0.84, 95% CI -1.11--0.57, p < 0.001) and mortality risk (aHR 0.895, 95% CI 0.818-0.973, p = 0.012).

Conclusion: Targeting Hgb level >8 g/dL in ECMO patients may help reduce ECMO duration.

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红细胞输血在体外膜氧合中的应用：一项单中心研究。

目的：评估输血实践及其对体外膜氧合（ECMO）配置的发病率和死亡率的影响。背景：随着ECMO在重症监护中的应用越来越多，理想的Hgb水平仍然不确定。虽然指南建议更高的剂量，但新出现的证据表明可能有害。我们的研究通过研究ECMO的最佳Hgb水平来解决这一差距。方法：一项回顾性队列研究包括2016年1月至2018年12月期间接受ECMO的所有成年患者。主要结局评估了与缩短ECMO持续时间和住院死亡率相关的最佳Hgb水平。进行多变量和cox -比例回归分析。结果：306例患者接受了ECMO，其中31例患者的平均Hgb水平为7-7.9 g/dL， 176例为8-8.9 g/dL， 72例为9-9.9 g/dL， 27例≥10 g/dL。平均（SD）年龄56岁（15岁），男性占60.8%（186/306）。ECMO构型以静脉动脉（VA）为主（59.8%），其次是静脉静脉（VV）（36.9%）和混合型（3.3%）。与≥10 g/dL Hgb组相比，7-7.9 g/dL Hgb组ECMO持续时间更长（平均17.5天，系数2.2,95% CI 0.02-4.4, p = 0.048），不同Hgb水平的死亡率无显著差异。VA ECMO患者的死亡风险明显高于VV ECMO患者（aHR 2.33, 95% CI 1.50-3.60, p）。结论：ECMO患者将Hgb水平控制在80 ~ 80 g/dL可能有助于缩短ECMO持续时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transfusion Medicine 医学-血液学

CiteScore

2.70

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Transfusion Medicine publishes articles on transfusion medicine in its widest context, including blood transfusion practice (blood procurement, pharmaceutical, clinical, scientific, computing and documentary aspects), immunohaematology, immunogenetics, histocompatibility, medico-legal applications, and related molecular biology and biotechnology. In addition to original articles, which may include brief communications and case reports, the journal contains a regular educational section (based on invited reviews and state-of-the-art reports), technical section (including quality assurance and current practice guidelines), leading articles, letters to the editor, occasional historical articles and signed book reviews. Some lectures from Society meetings that are likely to be of general interest to readers of the Journal may be published at the discretion of the Editor and subject to the availability of space in the Journal.