Transfusion practice in patients receiving VV ECMO (PROTECMO): a prospective, multicentre, observational study

Brodie, Daniel; Martucci, Gennaro; Arcadipane, Antonio; Pesenti, Antonio; Grasselli, Giacomo; Brioni, Matteo; Pascale, Gennaro De; Montini, Luca; Giani, Marco; Foti, Giuseppe; Bosa, Linda; Curcio, Pierfrancesco; Fanelli, Vito; Garofalo, Eugenio; Martín-Villén, Luis; Garcìa-Álvarez, Raquel; Sánchez, Marta López; Príncipe, Nuno; Saez, Violeta Chica; Chico, Juan Ignacio; Gómez, Vanesa Ávalos; Colomina-Climent, Joaquin; Riera, Jordi; Pacheco, Andrés; Gorjup, Vojka; Goutay, Julien; Duburcq, Thibault; Szułdrzyński, Konstanty; Eller, P.; Lobmeyr, Elisabeth; Schellongowski, Peter; Schmidt, Matthieu; Combes, Alain; Lorusso, Roberto; Mariani, Silvia; Ranieri, Marco; Suk, Pavel; Malý, Michal; Borggrefe, Martin; Forestier, Jakob; Broman, Lars; Rizzo, M.; Tuzzolino, F.; Tanaka, Kenichi A.; Holsworth, Tyler; Trethowan, Brian; Serra, Alexis; Agerstrand, Cara; Brodie, D.; Cavayas, Yiorgos Alexandros; Tabatabai, Ali; Menaker, Jay; Galvagno, Samuel M.; Gannon, Whitney D.; Rice, Todd W.; Grandin, Wilson; Nunez, Jose I; Cheplic, Collette; Ramanan, Raj; Rivosecchi, Ryan; Cho, Young-Jae; Buabbas, Sarah; Jeon, Kyeongman; Kwan, Ming Chit; Sallam, Hend; Villanueva, Joy Ann; Aliudin, Jeffrey; Hssain, Ali Ait; Hoshino, Kota; Hara, Yoshitaka; Ramanathan, Kollengode; MacLaren, Graeme; Buscher, Hergen

doi:10.1016/s2213-2600(22)00353-8

Cited by 36 publications

(27 citation statements)

References 27 publications

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“…In our center, a targeted hemoglobin concentration (Hb) for VV-ECMO of approximately 9 g/dL was mostly maintained throughout therapy (mean observed Hb 8.9 g/dL) with 1441 RBC transfusions. Our transfusion practice, thus, appears comparable to the literature, even though lower transfusion thresholds are increasingly being investigated [ 36 ]. Our observed correlation ( p < 0.001, r = 0.042) of RBC transfusion and the need for oxygenator change might be explained by the simultaneous administration of coagulation substitution due to bleeding events, which unfortunately was not recorded separately.…”

Section: Discussionsupporting

confidence: 60%

Therapy and Outcome of Prolonged Veno-Venous ECMO Therapy of Critically Ill ARDS Patients

Flinspach

Raimann

Bauer

et al. 2023

JCM

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Veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) therapy has become increasingly used and established in many hospitals as a routine treatment. With ECMO-therapy being a resource-demanding procedure, it is of interest whether a more prolonged VV-ECMO treatment would hold sufficient therapeutic success. Our retrospective study included all VV-ECMO runs from 1 January 2020 to 31 June 2022. We divided all runs into four groups (<14 days, 14–27, 28–49, 50+) of different durations and looked for differences overall in hospital survival. Additionally, corresponding treatments and therapeutic modalities, as well as laboratory results, were analyzed. We included 117 patients. Of those, 97 (82.9%) received a VV-ECMO treatment longer than two weeks. We did not find a significant association between ECMO duration (p = 0.15) and increased mortality though a significant correlation between the patients’ age and their probability of survival (p = 0.02). Notably, we found significantly lower interleukin-6 levels with an increase in therapy duration (p < 0.01). Our findings show no association between the duration of ECMO therapy and mortality. Thus, the treatment duration alone may not be used for making assumptions about the prospect of survival. However, attention is also increasingly focused on long-term outcomes, such as post-intensive care syndrome with severe impairments.

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Section: Discussionsupporting

confidence: 60%

Therapy and Outcome of Prolonged Veno-Venous ECMO Therapy of Critically Ill ARDS Patients

Flinspach

Raimann

Bauer

et al. 2023

JCM

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“…Prospective studies of transfusion strategies for ECMO patients are somewhat lacking, with variable practices encountered [ 31 , 45 , 52 , 53 , 54 ]; however, retrospective observational data suggest that a restrictive threshold of <80 g/L may be safe and provide substantial cost savings [ 55 ]. In a prospective international multicentre observational study of 604 patients receiving VVECMO, the mean pretransfusion threshold was 8.1 g/dL, and 83% of patients received at least one unit of blood during ECMO [ 56 ]. Transfusion was associated with lower risk of death only when the Hb was <7 g/dL [HR 0.15 (0.03–0.74)].…”

Section: Discussionmentioning

confidence: 99%

Haematological Trends and Transfusion during Adult Extracorporeal Membrane Oxygenation: A Single Centre Study

Worku

Win

Parmar

et al. 2023

JCM

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The temporal trends in haematological parameters and their associations with blood product transfusion requirements in patients supported with extracorporeal membrane oxygenation (ECMO) are poorly understood. We performed a retrospective data analysis to better understand the behaviour of haematological and coagulation parameters and their associations with transfusion requirements during ECMO. Methods: Patient demographics, haematological and coagulation parameters, plasma haemoglobin and fibrinogen concentrations, platelet count, the international normalised ratio (INR), the activated partial thromboplastin time (APTT), and blood product transfusion data from 138 patients who received ECMO in a single high-volume centre were analysed. Results: Ninety-two patients received venoarterial (VA) ECMO and 46 patients received venovenous (VV) ECMO. The median (IQR) duration of VA, and VV ECMO was 8 (5–13) days and 13 (8–23) days, respectively. There were significant reductions in haemoglobin, the platelet count, and the fibrinogen concentration upon initiation of ECMO. On average, over time, patients on VV ECMO had platelet counts 44 × 109/L higher than those on VA ECMO (p ≤ 0.001). Fibrinogen and APTT did not vary significantly based on the mode of ECMO (p = 0.55 and p = 0.072, respectively). A platelet count < 50 × 109/L or a fibrinogen level < 1.8 g/L was associated with 50% chance of PRBC transfusion, regardless of the ECMO type, and packed red blood cell (PRBC) transfusion was more common with VA ECMO. APTT was predictive of the transfusion requirement, and the decrement in APTT was discriminatory between VVECMO survivors and nonsurvivors. Conclusion: ECMO support is associated with reductions in haemoglobin, platelet count, and fibrinogen. Patients supported with VA ECMO are more likely to receive a PRBC transfusion compared to those on VV ECMO. Thrombocytopaenia, hypofibrinogenaemia, and anticoagulation effect the likelihood of requiring PRBC transfusion. Further research is needed to define optimal blood management during ECMO, including appropriate transfusion triggers and the anticoagulation intensity.

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“…4,13 By calculation, transfusion from 7.9 to 9.9 g/dL would have increased DO 2 -ECMO from 419 to only 507 mL/min (Table 1, event 3). 14 This would maintain a DO 2 /VO 2 ratio of 2.9—still below goal. Therefore, in addition to resuscitation including limited transfusion of red blood cells, the patient was reparalyzed, which successfully improved ECMO flow and Sv o 2 , enabling DO 2 /VO 2 ratios >3.…”

Section: Case Descriptionmentioning

confidence: 99%

Refractory Hypoxemia on VV-ECMO: Repetition of a Structured Approach Is Paramount: A Case Report

et al. 2023

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Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly used to manage severe respiratory failure. Unfortunately, refractory hypoxemia often complicates VV-ECMO support. Both circuit- and patient-related etiologies can drive this, and a structured approach is necessary to diagnose and treat the condition. We present the case of a patient on VV-ECMO for acute respiratory distress syndrome who suffered from several distinct etiologies of refractory hypoxemia over a short timeframe. Frequent recalculation of cardiac output and oxygen delivery enabled early diagnosis and treatment of these conditions. We highlight the need for a structured and oft-repeated approach to this complex problem.

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Transfusion practice in patients receiving VV ECMO (PROTECMO): a prospective, multicentre, observational study

Cited by 36 publications

References 27 publications

Therapy and Outcome of Prolonged Veno-Venous ECMO Therapy of Critically Ill ARDS Patients

Therapy and Outcome of Prolonged Veno-Venous ECMO Therapy of Critically Ill ARDS Patients

Haematological Trends and Transfusion during Adult Extracorporeal Membrane Oxygenation: A Single Centre Study

Refractory Hypoxemia on VV-ECMO: Repetition of a Structured Approach Is Paramount: A Case Report

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