Transfusion of red blood cells in venoarterial extracorporeal membrane oxygenation: A multicenter retrospective observational cohort study
Jorinde Raasveld, Mina Karami, Jimmy Schenk, Dinís Dos Reis Miranda, Loes Mandigers, Dieter Dauwe, Erwin De Troy, Federico Pappalardo, Evgeny Fominskiy, Walter M. van den Bergh, Annemieke Oude Lansink‐Hartgring, Franciska van der Velde, Jacinta J. Maas, Pablo van de Berg, Maarten de Haan, Dirk W. Donker, Christiaan L. Meuwese, Fabio Silvio Taccone, Lorenzo Peluso, Roberto Lorusso, Thijs Delnoij, Erik Scholten, Martijn Overmars, Višnja Ivančan, Robert Bojčić, Jesse de Metz, Bas van den Bogaard, Martin de Bakker, Benjamin Reddi, Greet Hermans, Lars Mikael Broman, Josè P.S. Henriques, Alexander P. J. Vlaar
Abstract
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.