Transfusion of red blood cells in venoarterial extracorporeal membrane oxygenation: A multicenter retrospective observational cohort study. (2024)

Affiliation

• Raasveld SJ; Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands.
• Karami M; Department of Cardiology, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, the Netherlands.
• Schenk J; Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands.
• Dos Reis Miranda D; Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location AMC, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands.
• Mandigers L; Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, the Netherlands.
• Dauwe DF; Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, the Netherlands.
• De Troy E; Department of Intensive Care Medicine, Surgical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
• Pappalardo F; Department of Intensive Care Medicine, Surgical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
• Fominskiy E; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Allesandria, Italy.
• van den Bergh WM; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• Oude Lansink-Hartgring A; Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
• van der Velde F; Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
• Maas JJ; Adult Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands.
• van de Berg P; Adult Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands.
• de Haan M; Adult Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
• Donker DW; Department of Extracorporeal Circulation, Catharina hospital Eindhoven, Eindhoven, the Netherlands.
• Meuwese CL; Intensive Care Center, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands.
• Taccone FS; Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, the Netherlands.
• Peluso L; Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, the Netherlands.
• Lorusso R; Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium.
• Delnoij TSR; Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium.
• Scholten E; Cardiothoracic surgery, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands.
• Overmars M; Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands.
• Ivancan V; Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands.
• Bojcic R; Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
• de Metz J; Department of Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands.
• van den Bogaard B; Department of Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands.
• de Bakker M; Department of Anesthesia and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
• Reddi B; Department of Anesthesia and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
• Hermans G; Department of Intensive Care, OLVG, Amsterdam, the Netherlands.
• Broman LM; Department of Intensive Care, OLVG, Amsterdam, the Netherlands.
• Henriques JPS; Department of Critical Care, Royal Adelaide Hospital, Adelaide, Australia.
• Vlaar APJ; Department of Critical Care, Royal Adelaide Hospital, Adelaide, Australia.

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.