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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.

Aim: Worldwide, cardiac arrest (CA) remains a major cause of death. Most post-CA patients are admitted to the intensive care unit (ICU). The aim of this study is to describe mortality rates and possible changes in mortality rates in patients with CA admitted to the ICU in the Netherlands between 2010 and 2016.Methods: In this study, we included all adult CA patients registered in the National Intensive Care Evaluation (NICE) registry who were admitted to ICUs in the Netherlands between 2010 and 2016. The primary outcome was 1-year mortality which was analysed by Cox regression. The secondary outcomes were ICU mortality and hospital mortality. Hospital mortality was analysed by binary logistic regression analysis. Patients were stratified by whether they experienced in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA). Finally, the outcome over calendar time was assessed for both groups.Results: We included 26,056 CA patients: 10,618 (40.8%) IHCA patients and 14,482 (55.6%) OHCA patients. The 1-year mortality rate was 57.5%: 59% for IHCA and 56.4% for OHCA, p < 0.01. This mortality rate remained stable between 2010 and 2016 for IHCA (p = 0.31) and declined for OHCA patients (p = 0.01). The hospital mortality rate was 50.3%: 50.5% for IHCA and 50.2% for OHCA, p = 0.66. This mortality rate remained stable between 2010À2016 for IHCA (p = 0.21) and decreased for OHCA patients (p < 0.01). An additional analysis with calendar year as a continuous variable showed a mortality decline of 1.56% per calendar year for 1-year mortality. Conclusion:This nationwide registry cohort study reported a 57.5% 1-year mortality rate for CA patients admitted to the ICU between 2010 and 2016.We reported a decline in 1-year mortality for OHCA patients in these years.

Objectives After cardiac arrest, a key factor determining survival outcomes is low-flow duration. Our aims were to determine the relation of survival and low-flow duration of extracorporeal cardiopulmonary resuscitation and conventional cardiopulmonary resuscitation and if these two therapies have different short term survival curves in relation to low-flow duration. Methods We searched Embase, Medline, Web of Science, and Google Scholar from inception up to April 2021. A linear mixed effect model was used to describe the course of survival over time, based on study-specific and time-specific aggregated survival data. Results We included 42 observational studies reporting on 1,689 extracorporeal cardiopulmonary resuscitation and 375,751 conventional cardiopulmonary resuscitation procedures. Of the included studies, 25 included adults, 13 included children, and four included both. In adults, survival curves decline rapidly over time (extracorporeal cardiopulmonary resuscitation 37.2%-29.8%-23.8%-19.1% versus conventional cardiopulmonary resuscitation-shockable 36.8%-7.2%-1.4%-0.3% for 15–30-45–60 min low-flow, respectively). extracorporeal cardiopulmonary resuscitation was associated with a statistically significant slower decline in survival than conventional cardiopulmonary resuscitation with initial shockable rhythms (conventional cardiopulmonary resuscitation-shockable). In children, survival curves decline rapidly over time (extracorporeal cardiopulmonary resuscitation 43.6%-41.7%-39.8%-38.0% versus CCPR-shockable 48.6%-20.5%-8.6%-3.6% for 15–30-45–60 min low-flow, respectively). extracorporeal cardiopulmonary resuscitation was associated with a statistically significant slower decline in survival than conventional cardiopulmonary resuscitation-shockable. Conclusions The short-term survival of extracorporeal cardiopulmonary resuscitation and conventional cardiopulmonary resuscitation-shockable patients both decline rapidly over time, in adults as well as in children. This decline of short-term survival in relation to low-flow duration in extracorporeal cardiopulmonary resuscitation was slower than in conventional cardiopulmonary resuscitation. Trial registration Prospero: CRD42020212480, 02-10-2020

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