TY - JOUR
T1 - RBC Transfusion in Venovenous Extracorporeal Membrane Oxygenation
T2 - A Multicenter Cohort Study
AU - Raasveld, Senta Jorinde
AU - Karami, Mina
AU - van den Bergh, Walter M.
AU - Lansink-Hartgring, Annemieke Oude
AU - van der Velde, Franciska
AU - Maas, Jacinta J.
AU - van de Berg, Pablo
AU - de Haan, Maarten
AU - Lorusso, Roberto
AU - Delnoij, Thijs S. R.
AU - Miranda, Dinis Dos Reis
AU - Mandigers, Loes
AU - Scholten, Erik
AU - Overmars, Martijn
AU - Taccone, Fabio Silvio
AU - Brasseur, Alexandre
AU - Dauwe, Dieter F.
AU - De Troy, Erwin
AU - Hermans, Greet
AU - Meersseman, Philippe
AU - Pappalardo, Federico
AU - Fominskiy, Evgeny
AU - Ivancan, Visnja
AU - Bojcic, Robert
AU - de Metz, Jesse
AU - van den Bogaard, Bas
AU - Donker, Dirk W.
AU - Meuwese, Christiaan L.
AU - de Bakker, Martin
AU - Reddi, Benjamin
AU - de Bruin, Sanne
AU - Lagrand, Wim K.
AU - Henriques, Jose P. S.
AU - Broman, Lars M.
AU - Vlaar, Alexander P. J.
PY - 2022/2
Y1 - 2022/2
N2 - 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 10.8 g/dL (8.9-13.0 g/dL), decreasing to 8.7 g/dL (7.7-9.8 g/dL) during extracorporeal membrane oxygenation. Nadir hemoglobin was lower on days when a transfusion was administered (8.1 g/dL [7.4-9.3 g/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 > 9 g/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.
AB - 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 10.8 g/dL (8.9-13.0 g/dL), decreasing to 8.7 g/dL (7.7-9.8 g/dL) during extracorporeal membrane oxygenation. Nadir hemoglobin was lower on days when a transfusion was administered (8.1 g/dL [7.4-9.3 g/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 > 9 g/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.
KW - extracorporeal membrane oxygenation
KW - mortality
KW - red blood cells
KW - threshold
KW - transfusion
KW - RESPIRATORY-FAILURE
KW - LIFE-SUPPORT
KW - REQUIREMENTS
KW - THRESHOLD
KW - ADULTS
U2 - 10.1097/CCM.0000000000005398
DO - 10.1097/CCM.0000000000005398
M3 - Article
SN - 0090-3493
VL - 50
SP - 224
EP - 234
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 2
ER -