A Systematic Literature Review of Packed Red Cell Transfusion Usage in Adult Extracorporeal Membrane Oxygenation

Abstract

Background: Blood product administration plays a major role in the management of patients treated with extracorporeal membrane oxygenation (ECMO) and may be a contributor to morbidity and mortality. Methods: We performed a systematic review of the published literature to determine the current usage of packed red cell transfusions. Predefined search criteria were used to identify journal articles reporting transfusion practice in ECMO by interrogating EMBASE and Medline databases and following the PRISMA statement. Results: Out of 1579 abstracts screened, articles reporting ECMO usage in a minimum of 10 adult patients were included. Full texts of 331 articles were obtained, and 54 were included in the final analysis. All studies were observational (2 were designed prospectively, and two were multicentre). A total of 3808 patients were reported (range 10–517). Mean exposure to ECMO was 8.2 days (95% confidence interval (CI) 7.0–9.4). A median of 5.6% was not transfused (interquartile range (IQR) 0–11.3%, 19 studies). The mean red cell transfusion per ECMO run was 17.7 units (CI 14.2–21.2, from 52 studies) or 2.60 units per day (CI 1.93–3.27, from 49 studies). The median survival to discharge was 50.8% (IQR 40.0–64.9%). Conclusion: Current evidence on transfusion practice in ECMO is mainly drawn from single-centre observational trials and varies widely. The need for transfusions is highly variable. Confounding factors influencing transfusion practice need to be identified in prospective multicentre studies to mitigate potential harmful effects and generate hypotheses for interventional trials.

The hemoglobin level impact on arterial oxygen saturation during venous-venous-extracorporeal membrane oxygenation support of acute respiratory distress syndrome patients: a mathematical marginal approach

“…( 1 ) High volume ECMO centers are used to more restrictive Hb strategies, although there is no consensus on a definitive transfusion approach. ( 2 ) Conversely, some experienced centers use higher Hb thresholds for transfusion and accept oxygen arterial saturation (SatO 2 ) as low as 70% with excellent clinical outcomes. ( 3 )…”

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

“…Since alterations of hemostasis (bleeding and thrombosis) are common complications of extracorporeal membrane oxygenation [ 150 ], the use of packed red blood cells (PRBC), as well as plasma, platelets, and blood components, is common during ECMO treatment. A recent meta-analysis concluded that, on average, 2.6 units of PRBCs are transfused per day on ECMO [ 151 ]. Therefore, the refusal for blood transfusions, most often encountered in patients of Jehovah’s Witness faith, could be counted as a contraindication for the use of ECMO.…”

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

“…1 About 94% of patients require at least one packed red blood cell (pRBC) transfusion, and patients consume a mean 17.7 units of pRBC per ECMO run or 2.6 units of pRBC per day. 2 The primary aims of red cell transfusion are to correct volume loss and increase oxygen delivery. However, studies in healthy volunteers have shown that oxygen consumption could be independent of oxygen delivery at hemoglobin levels as low as 5 g/dl.…”