Restrictive and liberal transfusion strategies in extracorporeal membrane oxygenation : A retrospective observational study
© 2022 AABB..
BACKGROUND: To compare the outcomes of patients requiring extracorporeal membrane oxygenation (ECMO) support who had a restrictive transfusion strategy with those who had a liberal strategy.
STUDY DESIGN AND METHODS: We retrospectively reviewed all adult patients from 2010 to 2019 who received a minimum of one packed red blood cell (pRBC) during ECMO. Hemoglobin values before each transfusion were retrieved. Restrictive transfusion strategy was defined as a transfusion threshold ≤8.5 g/dl in all transfusion episodes for a single patient, while liberal transfusion strategy was defined as a transfusion threshold >8.5 g/dl in any transfusion episode.
RESULTS: The analysis included 763 patients, with 138 (18.1%) patients in the restrictive and 625 (81.9%) in the liberal transfusion strategy group. The median hemoglobin level, taking into account all measured hemoglobin values, during ECMO support was 8.3 and 9.9 g/dl, and the average units of pRBC received per day were 0.7 (0.3-1.8) and 1.2 (0.6-2.3), respectively. There were no significant differences in intensive care unit (ICU) mortality (adjusted odds ratio (OR), 0.86; 95% CI 0.56-1.30; p = .47), hospital mortality (adjusted OR, 0.79; 95% CI 0.52-1.21; p = .28), and 90-day mortality (adjusted OR, 0.84; 95% CI 0.55-1.28; p = .42) between the two groups. Among subgroup analyses, a restrictive transfusion strategy was associated with decreased risk of ICU mortality in patients on veno-venous ECMO (adjusted OR, 0.36; 95% CI 0.17-0.73; p = .005). There was no heterogeneity on outcomes across patients stratified by age, APACHE IV score, or need for large volume transfusion.
DISCUSSION: Our data suggested it may be safe to adopt a restrictive red cell transfusion threshold of 8.5 g/dl in patients on ECMO, and highlighted the need for prospective trials in this heavily-transfused population.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:63 |
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| Enthalten in: |
Transfusion - 63(2023), 2 vom: 21. Feb., Seite 294-304 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ng, Pauline Yeung [VerfasserIn] |
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| Links: |
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| Themen: |
ECMO |
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| Anmerkungen: |
Date Completed 06.02.2023 Date Revised 02.03.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/trf.17221 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM350235341 |
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| 100 | 1 | |a Ng, Pauline Yeung |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Restrictive and liberal transfusion strategies in extracorporeal membrane oxygenation |b A retrospective observational study |
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| 520 | |a © 2022 AABB. | ||
| 520 | |a BACKGROUND: To compare the outcomes of patients requiring extracorporeal membrane oxygenation (ECMO) support who had a restrictive transfusion strategy with those who had a liberal strategy | ||
| 520 | |a STUDY DESIGN AND METHODS: We retrospectively reviewed all adult patients from 2010 to 2019 who received a minimum of one packed red blood cell (pRBC) during ECMO. Hemoglobin values before each transfusion were retrieved. Restrictive transfusion strategy was defined as a transfusion threshold ≤8.5 g/dl in all transfusion episodes for a single patient, while liberal transfusion strategy was defined as a transfusion threshold >8.5 g/dl in any transfusion episode | ||
| 520 | |a RESULTS: The analysis included 763 patients, with 138 (18.1%) patients in the restrictive and 625 (81.9%) in the liberal transfusion strategy group. The median hemoglobin level, taking into account all measured hemoglobin values, during ECMO support was 8.3 and 9.9 g/dl, and the average units of pRBC received per day were 0.7 (0.3-1.8) and 1.2 (0.6-2.3), respectively. There were no significant differences in intensive care unit (ICU) mortality (adjusted odds ratio (OR), 0.86; 95% CI 0.56-1.30; p = .47), hospital mortality (adjusted OR, 0.79; 95% CI 0.52-1.21; p = .28), and 90-day mortality (adjusted OR, 0.84; 95% CI 0.55-1.28; p = .42) between the two groups. Among subgroup analyses, a restrictive transfusion strategy was associated with decreased risk of ICU mortality in patients on veno-venous ECMO (adjusted OR, 0.36; 95% CI 0.17-0.73; p = .005). There was no heterogeneity on outcomes across patients stratified by age, APACHE IV score, or need for large volume transfusion | ||
| 520 | |a DISCUSSION: Our data suggested it may be safe to adopt a restrictive red cell transfusion threshold of 8.5 g/dl in patients on ECMO, and highlighted the need for prospective trials in this heavily-transfused population | ||
| 650 | 4 | |a Observational Study | |
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| 700 | 1 | |a Ip, April |e verfasserin |4 aut | |
| 700 | 1 | |a Ling, Lowell |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Kai Man |e verfasserin |4 aut | |
| 700 | 1 | |a Leung, Kit Hung Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, King Chung Kenny |e verfasserin |4 aut | |
| 700 | 1 | |a So, Dominic |e verfasserin |4 aut | |
| 700 | 1 | |a Shum, Hoi Ping |e verfasserin |4 aut | |
| 700 | 1 | |a Ngai, Chun Wai |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Wai Ming |e verfasserin |4 aut | |
| 700 | 1 | |a Sin, Wai Ching |e verfasserin |4 aut | |
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