Hope T Jackson1, Tolulope A Oyetunji2, Alexandra Thomas3, Aderonke O Oyetunji4, Miller Hamrick3, Evan P Nadler3, Edward Wong5, Faisal G Qureshi6. 1. Department of Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia. 2. Department of Surgery, Howard University College of Medicine, Washington, District of Columbia. 3. Department of Pediatric Surgery, Children's National Medical Center, Washington, District of Columbia. 4. Department of the Health Management, Merrick School of Business, University of Baltimore, Baltimore Maryland. 5. Department of Laboratory Medicine, Children's National Medical Center, Washington, District of Columbia. 6. Department of Pediatric Surgery, Children's National Medical Center, Washington, District of Columbia. Electronic address: fqureshi@childrensnational.org.
Abstract
BACKGROUND: Blood products containing leukocytes have been associated with negative immunomodulatory and infectious effects. Transfusion-related acute lung injury is partially explained by leucocyte agglutination. The Food and Drug Administration has therefore recommended leukoreduction strategies for blood product transfusion. Our institution has been using leukocyte-reduced blood via filtration for neonates on Extracorporeal Membrane Oxygenation (ECMO). We hypothesized that the use of leukocyte-reduced blood would decrease mortality and morbidity of neonatal ECMO patients. METHODS: Retrospective review of noncardiac ECMO in neonates from 1984-2011, stratified into year groups I and II (≤1996 and ≥1997). Demographics, duration and type of ECMO, complications, and outcome data were collected. Blood product use data was collected. Univariate, bivariate, and multivariate analyses determined predictors of risk-adjusted mortality by year group. RESULTS: Patients (827) underwent ECMO with 65.3% (540) in group I. Overall median blood product use in mL/kg/d was 36.2 packed red blood cells (pRBC), 8.1 platelets, and 0 cyroprecipitate and/or fresh-frozen plasma. Overall mortality was 16.4%. Median pRBC used or transfused was 42.1 mL/kg/d in group I versus 19.1 mL/kg/d group II (P <0.001). On bivariate analysis, there was no difference in crude mortality between the 2 year groups (17.2% versus 16.0%, P = 0.66). However, on multivariate analysis adjusting for demographics, diagnosis, complications, and blood product use other than pRBCs, each additional transfusion of 10 mL/kg/d of pRBC was associated with a 33% increase in mortality in group I (P <0.05). Group II also showed an increase in mortality with each additional transfusion (21%) but this was not statistically significant (P = 0.07). Days on ECMO were not associated with pRBC transfusion in group I but increased in group II (additional 3 d for each 10 mL/kg/d transfused). There was no difference in infectious complications between groups I and II. CONCLUSIONS: Blood transfusion requirement has diminished in newborns undergoing ECMO at our institution. Transfusion of non leukocyte-reduced blood is associated with an increase in mortality whereas transfusion of leukocyte-reduced blood provided no benefit with a trend toward increased mortality. Further research is recommended to understand these trends.
BACKGROUND: Blood products containing leukocytes have been associated with negative immunomodulatory and infectious effects. Transfusion-related acute lung injury is partially explained by leucocyte agglutination. The Food and Drug Administration has therefore recommended leukoreduction strategies for blood product transfusion. Our institution has been using leukocyte-reduced blood via filtration for neonates on Extracorporeal Membrane Oxygenation (ECMO). We hypothesized that the use of leukocyte-reduced blood would decrease mortality and morbidity of neonatal ECMO patients. METHODS: Retrospective review of noncardiac ECMO in neonates from 1984-2011, stratified into year groups I and II (≤1996 and ≥1997). Demographics, duration and type of ECMO, complications, and outcome data were collected. Blood product use data was collected. Univariate, bivariate, and multivariate analyses determined predictors of risk-adjusted mortality by year group. RESULTS:Patients (827) underwent ECMO with 65.3% (540) in group I. Overall median blood product use in mL/kg/d was 36.2 packed red blood cells (pRBC), 8.1 platelets, and 0 cyroprecipitate and/or fresh-frozen plasma. Overall mortality was 16.4%. Median pRBC used or transfused was 42.1 mL/kg/d in group I versus 19.1 mL/kg/d group II (P <0.001). On bivariate analysis, there was no difference in crude mortality between the 2 year groups (17.2% versus 16.0%, P = 0.66). However, on multivariate analysis adjusting for demographics, diagnosis, complications, and blood product use other than pRBCs, each additional transfusion of 10 mL/kg/d of pRBC was associated with a 33% increase in mortality in group I (P <0.05). Group II also showed an increase in mortality with each additional transfusion (21%) but this was not statistically significant (P = 0.07). Days on ECMO were not associated with pRBC transfusion in group I but increased in group II (additional 3 d for each 10 mL/kg/d transfused). There was no difference in infectious complications between groups I and II. CONCLUSIONS: Blood transfusion requirement has diminished in newborns undergoing ECMO at our institution. Transfusion of non leukocyte-reduced blood is associated with an increase in mortality whereas transfusion of leukocyte-reduced blood provided no benefit with a trend toward increased mortality. Further research is recommended to understand these trends.
Authors: Christopher R Reed; Desiree Bonadonna; Jeffrey Everitt; Victoria Robinson; James Otto; Elisabeth T Tracy Journal: J Extra Corpor Technol Date: 2020-09
Authors: Jennifer A Muszynski; Ron W Reeder; Mark W Hall; Robert A Berg; Thomas P Shanley; Christopher J L Newth; Murray M Pollack; David Wessel; Joseph Carcillo; Rick Harrison; Kathleen L Meert; J Michael Dean; Tammara Jenkins; Robert F Tamburro; Heidi J Dalton Journal: Crit Care Med Date: 2018-06 Impact factor: 7.598
Authors: Katherine Cashen; Ron Reeder; Heidi J Dalton; Robert A Berg; Thomas P Shanley; Christopher J L Newth; Murray M Pollack; David Wessel; Joseph Carcillo; Rick Harrison; J Michael Dean; Tammara Jenkins; Kathleen L Meert Journal: Pediatr Crit Care Med Date: 2017-06 Impact factor: 3.624