RBC Transfusion in Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Cohort Study

Senta Jorinde Raasveld, Mina Karami, Walter M. van den Bergh, Annemieke Oude Lansink-Hartgring, Franciska van der Velde, Jacinta J. Maas, Pablo van de Berg, Maarten de Haan, Roberto Lorusso, Thijs S. R. Delnoij, Dinis Dos Reis Miranda, Loes Mandigers, Erik Scholten, Martijn Overmars, Fabio Silvio Taccone, Alexandre Brasseur, Dieter F. Dauwe, Erwin de Troy, Greet Hermans, Philippe MeerssemanFederico Pappalardo, Evgeny Fominskiy, Višnja Ivancan, Robert Bojčić, Jesse de Metz, Bas van den Bogaard, Dirk W. Donker, Christiaan L. Meuwese, Martin de Bakker, Benjamin Reddi, Sanne de Bruin, Wim K. Lagrand, José P. S. Henriques, Lars M. Broman, Alexander P. J. Vlaar

Research output: Contribution to journalArticle*Academicpeer-review

Abstract

OBJECTIVES: In the general critical care patient population, restrictive transfusion regimen of RBCs has been shown to be safe and is yet implemented worldwide. However, in patients on venovenous extracorporeal membrane oxygenation, guidelines suggest liberal thresholds, and a clear overview of RBC transfusion practice is lacking. This study aims to create an overview of RBC transfusion in venovenous extracorporeal membrane oxygenation. DESIGN: Mixed method approach combining multicenter retrospective study and survey. SETTING: Sixteen ICUs worldwide. PATIENTS: Patients receiving venovenous extracorporeal membrane oxygenation between January 2018 and July 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the proportion receiving RBC, the amount of RBC units given daily and in total. Furthermore, the course of hemoglobin over time during extracorporeal membrane oxygenation was assessed. Demographics, extracorporeal membrane oxygenation characteristics, and patient outcome were collected. Two-hundred eight patients received venovenous extracorporeal membrane oxygenation, 63% male, with an age of 55 years (45–62 yr), mainly for acute respiratory distress syndrome. Extracorporeal membrane oxygenation duration was 9 days (5–14 d). Prior to extracorporeal membrane oxygenation, hemoglobin was 10.8g/dL (8.9–13.0g/dL), decreasing to 8.7g/dL (7.7–9.8g/dL) during extracorporeal membrane oxygenation. Nadir hemoglobin was lower on days when a transfusion was administered (8.1g/dL [7.4–9.3g/dL]). A vast majority of 88% patients received greater than or equal to 1 RBC transfusion, consisting of 1.6 U (1.3–2.3 U) on transfusion days. This high transfusion occurrence rate was also found in nonbleeding patients (81%). Patients with a liberal transfusion threshold (hemoglobin > 9g/dL) received more RBC in total per transfusion day and extracorporeal membrane oxygenation day. No differences in survival, hemorrhagic and thrombotic complication rates were found between different transfusion thresholds. Also, 28-day mortality was equal in transfused and nontransfused patients. CONCLUSIONS: Transfusion of RBC has a high occurrence rate in patients on venovenous extracorporeal membrane oxygenation, even in nonbleeding patients. There is a need for future studies to find optimal transfusion thresholds and triggers in patients on extracorporeal membrane oxygenation.

Original languageEnglish
Pages (from-to)224-234
Number of pages11
JournalCritical care medicine
Volume50
Issue number2
DOIs
Publication statusPublished - 1 Feb 2022

Keywords

  • Extracorporeal membrane oxygenation
  • Mortality
  • Red blood cells
  • Threshold
  • Transfusion

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