Restrictive and liberal transfusion strategies in extracorporeal membrane oxygenation: A retrospective observational study.

Autor: Ng PY; Department of Medicine, The University of Hong Kong, Hong Kong, China.; Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China., Chan HCV; Department of Medicine, The University of Hong Kong, Hong Kong, China., Ip A; Department of Medicine, The University of Hong Kong, Hong Kong, China., Ling L; Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China., Chan KM; Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China., Leung KHA; Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong, China., Chan KCK; Department of Intensive Care, Tuen Mun Hospital, Hong Kong, China., So D; Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China., Shum HP; Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China., Ngai CW; Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China., Chan WM; Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China., Sin WC; Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China.; Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2023 Feb; Vol. 63 (2), pp. 294-304. Date of Electronic Publication: 2022 Dec 13.
DOI: 10.1111/trf.17221
Abstrakt: 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.
(© 2022 AABB.)
Databáze: MEDLINE
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