Predictors of red blood cell transfusion and its association with prognosis in patients undergoing extracorporeal membrane oxygenation

Pinto, Hugo Lo; Allyn, Jérôme; Persichini, Romain; Bouchet, Bruno; Brochier, Gilbert; Martinet, Olivier; Brulliard, Caroline; Valance, Dorothée; Delmas, Benjamin; Braunberger, Éric; Dangers, Laurence; Allou, Nicolas

doi:10.1177/0391398818785132

Cited by 15 publications

(24 citation statements)

References 32 publications

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“…These patients required significantly higher amounts of blood products (by a factor of 2.5 more RBCs) and tended to a higher proportion of ARF during ECMO. Another retrospective study from [25] demonstrated that RBC transfusion during ECMO was associated with severe complications (thromboembolic complications, sepsis, hemolysis) and ARF. Red cell damage during storage and the potential harmful consequences after transfusion are discussed in literature-in particular in massive transfusion scenarios [26].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

et al. 2020

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Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) are effective support modalities to treat critically ill patients. ECMO-associated hemolysis remains a serious complication. The aim was to disclose similarities and differences in VAand VV ECMO-associated hemolysis. This is a retrospective single-center analysis (January 2012 to September 2018) including 1,063 adult consecutive patients (VA, n = 606; VV, n = 457). Severe hemolysis (free plasma hemoglobin, fHb > 500 mg/l) during therapy occurred in 4% (VA) and 2% (VV) (p�0.001). VV ECMO showed significantly more hemolysis by pump head thrombosis (PHT) compared to VA ECMO (9% vs. 2%; p�0.001). Pretreatments (ECPR, cardiac surgery) of patients who required VA ECMO caused high fHb pre levels which aggravates the proof of ECMO-induced hemolysis (median (interquartile range), VA: fHb pre: 225.0 (89.3-458.0); VV: fHb pre: 72.0 (42.0-138.0); p�0.001). The survival rate to discharge from hospital differed depending on ECMO type (40% (VA) vs. 63% (VV); p�0.001). Hemolysis was dominant in VA ECMO patients, mainly caused by different indications and not by the ECMO support itself. PHT was the most severe form of ECMOinduced hemolysis that occurs in both therapies with low frequency, but more commonly in VV ECMO due to prolonged support time. OPEN ACCESS Citation: Appelt H, Philipp A, Mueller T, Foltan M, Lubnow M, Lunz D, et al. (2020) Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)-Comparison of VA-versus VV ECMO. PLoS ONE 15(1): e0227793.

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Section: Discussionmentioning

confidence: 99%

Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

et al. 2020

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“…38,39 Consequently, the adoption of more restrictive transfusion protocols, inferred from the lower accepted Hb, may be one of the contributing factors in higher survival and better clinical outcomes. 40…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin trigger and approach to red blood cell transfusions during veno-venous extracorporeal membrane oxygenation: the international TRAIN-ECMO survey

et al. 2019

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Introduction: Optimal red blood cell transfusion practice during veno-venous extracorporeal membrane oxygenation (VV ECMO) is still under debate. This survey aimed to assess the Hb trigger (also comparing with other critically ill patients) and major physiologic determinants considered for transfusions during veno-venous extracorporeal membrane oxygenation. Methods: Voluntary Web-based survey, endorsed by the European Society of Intensive Care Medicine, conducted among VV ECMO pratictioners worldwide. Results: A total of 447 respondents worldwide answered the questionnaire: 277 (61.9%) from Europe, 99 (22.1%) from North America, 36 (8.2%) from Asia and Oceania, and 35 (7.8%) from Central and South America. Among the respondents, 59.2% managed less than 12 venous extracorporeal membrane oxygenation runs/year, 19.4% between 12 and 24 runs/year, and 21.4% more than 24 runs/year. Of the respondents, 54.4% do not use a predefined Hb trigger in veno-venous extracorporeal membrane oxygenation, and, while the rate of adoption of a defined trigger varied worldwide, the effective value of Hb did not differ significantly among macro-regions. In patients on veno-venous extracorporeal membrane oxygenation, the Hb trigger to initiate red blood cell transfusion, was higher than in other critically ill patients: 9.1 ± 1.8 g/dL versus 8.3 ± 1.7 g/dL, p < 0.01. The Hb trigger was lower in centers with more than 24 venous extracorporeal membrane oxygenation runs/year (8.4 mg/dL (95% CI: 7.7-8.9)); (8.9 mg/dL (95% CI: 8.2-9.7)) in centers with between 12 and 24 venous extracorporeal membrane oxygenation runs/year; and (9.6 mg/dL (95% CI: 9.1-10.0)) in centers with fewer than 12 venous extracorporeal membrane oxygenation runs/year (p < 0.01). Several and variable adjunctive parameters are considered in cases of uncertainty for transfusion: the principal are hemodynamic status, SvO2, lactates, and fluid balance. Conclusion: Although the use of a predefined Hb trigger is still under-adopted among centers with low or median extracorporeal membrane oxygenation case volume, the majority of respondents use a higher Hb trigger for veno-venous extracorporeal membrane oxygenation patients compared with other critically ill patients. Higher volume centers tolerate lower Hb levels.

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“…The modulation of the immune response by transfusion may promote the development of postoperative infectious complications [24,25]. A transfusion in patients supported with VA-ECMO is also known to increase infectious complications [26]. In the present study, beyond the risk associated with low cardiac output and surgical reoperation itself, 34% of HTx recipients received a postoperative transfusion despite a restrictive strategy of blood transfusion in our institution, thereby increasing the risk of postoperative pneumonia.…”

Section: Non-documented Infections 2 (2)mentioning

confidence: 66%

Predictive risk factors for postoperative pneumonia after heart transplantation

et al. 2020

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Background: Pneumonia is a frequent complication in patients undergoing heart transplantation (HTx) that increases morbidity and mortality in this population. Nevertheless, the risk factors for postoperative pneumonia (POP) are still unknown. The aim of this study was to investigate the predictive risk factors for POP in HTx recipients. Methods: In this retrospective study, all patients undergoing HTx between January 2014 and December 2015 were included. All cases of POP occurring until hospital discharge were investigated. The study aimed to determine risk factors using univariate and multivariate Cox regression models. Data are expressed in Odds Ratio [95% CI]. P < 0.05 was necessary to reject the null hypothesis.Results: A total of 175 patients were included without any patients being lost to follow-up, and 89 instances of POP were diagnosed in 59 (34%) patients. Enterobacteriaceae and Pseudomonas aeruginosa were the most common pathogens. In the multivariate analysis, the risk factors were preoperative mechanical ventilation (OR 1.42 [1.12-1.80], P < 0.01) and perioperative blood transfusion (OR 1.42 [95% CI: 1.20-1.70], P < 0.01). POP significantly impacted mortality at 30 days (OR: 4 [1.3-12.4], P = 0.01) and 1 year (OR: 6.8 [2.5-8.4], P < 0.01) and was associated with a longer duration of mechanical ventilation, time to weaning from venoarterial extracorporeal membrane oxygenation and stay in an intensive care unit. Plasma exchanges and intravenous administration of immunoglobulins did not increase the risk of POP. Conclusion: After HTx, preoperative mechanical ventilation and blood transfusion were risk factors for POP and were associated with increased mortality. Enterobacteriaceae and Pseudomonas aeruginosa are the most common pathogens of POP.

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Predictors of red blood cell transfusion and its association with prognosis in patients undergoing extracorporeal membrane oxygenation

Cited by 15 publications

References 32 publications

Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

Hemoglobin trigger and approach to red blood cell transfusions during veno-venous extracorporeal membrane oxygenation: the international TRAIN-ECMO survey

Predictive risk factors for postoperative pneumonia after heart transplantation

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