BACKGROUND: Patients requiring extracorporeal membrane oxygenation (ECMO) support are critically ill and have substantial transfusion requirements, which convey both risks and benefits. A retrospective analysis was conducted to assess the association between blood component administration and adverse outcomes in adult, pediatric, and neonatal ECMO patients. METHODS: We evaluated 217 ECMO patients at a single center hospitalized between January 2009 and June 2016. Three cohorts (88 adult, 57 pediatric, and 72 neonatal patients) were included for assessment of patient characteristics, blood utilization, and clinical outcomes. Univariable and multivariable analyses were used to assess the association between transfusions and clinical outcomes (primary outcome: mortality and secondary outcomes: morbid events). The analysis included the main exposure of interest (total number of blood component units transfused) and potential confounding variables (age group cohort, case mix index, sex, ECMO mode and duration, and primary ECMO indication). RESULTS: After adjustment for confounders, with each additional blood component unit transfused, there was an estimated increase in odds for mortality by 1% (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.00-1.02; P = .013) and an increase in odds for thrombotic events by 1% (OR = 1.01; 95% CI, 1.00-1.02; P = .007). Mortality was higher in the adult (57 of 88; 64.8%) and pediatric (37 of 57; 64.9%) than in the neonatal cohort (19 of 72; 26.4%) (P < .0001). Median total blood components transfused per day followed a similar pattern for the adult (2.3 units; interquartile range [IQR] = 0.8-7.0), pediatric (2.9 units; IQR = 1.1-10), and neonatal (1.0 units; IQR = 0.7-1.6) cohorts (P < .0001). Over the entire hospitalization, the total median blood components transfused was highest in the neonatal (41 units; IQR = 24-94) and pediatric (41 units; IQR = 17-113) compared to the adult (30 units; IQR = 9-58) cohort (P = .007). There was no significant interaction between total units transfused over the hospital stay and age cohort for mortality (P = .35). CONCLUSIONS: Given the association between transfusion and adverse outcomes, effective blood management strategies may be beneficial in ECMO patients.
BACKGROUND: Patients requiring extracorporeal membrane oxygenation (ECMO) support are critically ill and have substantial transfusion requirements, which convey both risks and benefits. A retrospective analysis was conducted to assess the association between blood component administration and adverse outcomes in adult, pediatric, and neonatal ECMO patients. METHODS: We evaluated 217 ECMO patients at a single center hospitalized between January 2009 and June 2016. Three cohorts (88 adult, 57 pediatric, and 72 neonatal patients) were included for assessment of patient characteristics, blood utilization, and clinical outcomes. Univariable and multivariable analyses were used to assess the association between transfusions and clinical outcomes (primary outcome: mortality and secondary outcomes: morbid events). The analysis included the main exposure of interest (total number of blood component units transfused) and potential confounding variables (age group cohort, case mix index, sex, ECMO mode and duration, and primary ECMO indication). RESULTS: After adjustment for confounders, with each additional blood component unit transfused, there was an estimated increase in odds for mortality by 1% (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.00-1.02; P = .013) and an increase in odds for thrombotic events by 1% (OR = 1.01; 95% CI, 1.00-1.02; P = .007). Mortality was higher in the adult (57 of 88; 64.8%) and pediatric (37 of 57; 64.9%) than in the neonatal cohort (19 of 72; 26.4%) (P < .0001). Median total blood components transfused per day followed a similar pattern for the adult (2.3 units; interquartile range [IQR] = 0.8-7.0), pediatric (2.9 units; IQR = 1.1-10), and neonatal (1.0 units; IQR = 0.7-1.6) cohorts (P < .0001). Over the entire hospitalization, the total median blood components transfused was highest in the neonatal (41 units; IQR = 24-94) and pediatric (41 units; IQR = 17-113) compared to the adult (30 units; IQR = 9-58) cohort (P = .007). There was no significant interaction between total units transfused over the hospital stay and age cohort for mortality (P = .35). CONCLUSIONS: Given the association between transfusion and adverse outcomes, effective blood management strategies may be beneficial in ECMO patients.
Authors: Michael Mazzeffi; John Greenwood; Kenichi Tanaka; Jay Menaker; Raymond Rector; Daniel Herr; Zachary Kon; Joy Lee; Bartley Griffith; Keshava Rajagopal; Si Pham Journal: Ann Thorac Surg Date: 2015-10-09 Impact factor: 4.330
Authors: Steven M Frank; Linda M S Resar; James A Rothschild; Elizabeth A Dackiw; Will J Savage; Paul M Ness Journal: Transfusion Date: 2013-04-29 Impact factor: 3.157
Authors: Jerry L Stonemetz; Paul X Allen; Jack Wasey; Richard J Rivers; Paul M Ness; Steven M Frank Journal: Transfusion Date: 2014-02-24 Impact factor: 3.157
Authors: Conor P O'Halloran; Peta M A Alexander; Kristofer G Andren; Jessica Mecklosky; Joshua W Salvin; Stephanie Larsen; Jill Zalieckas; Francis Fynn-Thompson; Ravi R Thiagarajan Journal: Pediatr Crit Care Med Date: 2018-08 Impact factor: 3.624
Authors: Ryan P Barbaro; Folafoluwa O Odetola; Kelley M Kidwell; Matthew L Paden; Robert H Bartlett; Matthew M Davis; Gail M Annich Journal: Am J Respir Crit Care Med Date: 2015-04-15 Impact factor: 21.405
Authors: Jean Louis Vincent; Jean-François Baron; Konrad Reinhart; Luciano Gattinoni; Lambert Thijs; Andrew Webb; Andreas Meier-Hellmann; Guy Nollet; Daliana Peres-Bota Journal: JAMA Date: 2002-09-25 Impact factor: 56.272
Authors: Sebastian D Sahli; Alexander Kaserer; Donat R Spahn; Markus J Wilhelm; Julia Braun; Maximilian Halbe; Yuliya Dahlem; Muriel A Spahn; Julian Rössler; Bernard Krüger; Francesco Maisano Journal: J Thorac Dis Date: 2022-06 Impact factor: 3.005