Red blood cell transfusion volume and mortality among patients receiving extracorporeal membrane oxygenation

Perfusion (United Kingdom) - Tập 28 Số 1 - Trang 54-60 - 2013
Andrew Smith1,2, DC Hardison3, B. Berly Bridges1, Pietsch Jb4
1Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University School of Medicine, Nashville, Tennessee, USA
2Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University School of Medicine, Nashville, Tennessee, USA
3Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University School of Medicine, Nashville, Tennessee, USA
4Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University School of Medicine, Nashville, Tennessee, USA

Tóm tắt

Background: Red blood cell (RBC) transfusion is used in the critically ill with low hemoglobin concentrations to optimize oxygen utilization and delivery imbalance. Data suggest that RBC transfusion is also independently associated with significant morbidity. We seek to characterize RBC transfusion volumes among patients receiving extracorporeal membrane oxygenation (ECMO) support and test the hypothesis that red blood cell transfusion volume is an independent risk factor for mortality. Methods: Records of all patients receiving ECMO support from 2001 through 2010 at a university-affiliated children’s hospital were retrospectively reviewed. Results: Among 484 ECMO runs reviewed, indications for ECMO were classified as cardiac (40%), non-cardiac (42%) or institution of ECMO during cardiopulmonary resuscitation (CPR) (18%). Median duration of ECMO support was 4.6 days, with overall survival to hospital discharge significantly higher among non-cardiac patients (60%) relative to patients supported for cardiac (37%) or external CPR (ECPR) indications (34%, p<0.001). Median RBC transfusion volumes with respect to ECMO indication were significantly greater among cardiac (105 mL/kg/day ECMO) and ECPR patients (66 mL/kg/day ECMO) relative to patients supported for non-cardiac indications (20 mL/kg/day ECMO, p<0.001). Among patients supported with ECMO for non-cardiac indications alone (n=203), independent of covariates, including weight, venoarterial mode of ECMO support, presence of congenital diaphragmatic hernia and complications, including hemorrhage, neurologic injury, and renal insufficiency, each RBC transfusion volume of 10 mL/kg/day ECMO was associated with a 24% increase in the odds of in-hospital mortality (OR 1.024, 95% CI 1.004-1.046, p=0.018). Conclusions: Greater red blood cell transfusion volumes among patients supported with ECMO for non-cardiac indications are independently associated with an increase in odds of mortality. A prospective investigation of restrictive RBC transfusion practices while receiving ECMO may be warranted in this population.

Từ khóa


Tài liệu tham khảo

10.1164/rccm.200711-1637OC

10.1097/CCM.0b013e3181cc4d4b

10.1056/NEJMp038138

10.1111/j.1537-2995.2010.02816.x

10.1086/656246

10.1097/PCC.0b013e3181e30d43

10.1016/j.athoracsur.2010.07.037

10.1097/00003246-199307000-00018

10.1016/S0022-5223(19)34156-X

10.1161/CIRCULATIONAHA.106.680678

10.1016/j.athoracsur.2008.12.079

10.1016/S0022-3468(03)00270-7

10.1016/S0022-3468(97)90715-6

10.1016/S0022-5223(95)70119-2

10.1177/0885066604267650

10.1016/j.hlc.2008.08.009

10.1016/j.athoracsur.2010.11.078

10.1053/j.semperi.2005.02.005

10.1016/S0895-4356(96)00236-3

Green J, King MR, Leibeg LL, The 2007 National Blood Collection and Utilization Survey. 2007: 66.

10.1161/CIRCULATIONAHA.107.698977

10.1097/01.CCM.0000217920.48559.D8

10.1001/jama.2010.1406

10.1007/s00134-009-1661-7

10.1097/MAT.0b013e318190b6f7

10.1097/CCM.0b013e3181bc8293

10.1007/s00134-004-2352-z

10.1186/cc7735

10.1046/j.1537-2995.1990.30490273436.x

10.1046/j.1537-2995.1996.36196190517.x

10.1111/j.1423-0410.2008.01110.x

10.1056/NEJMoa066240

Thông tin
Thông tin xuất bản

Perfusion (United Kingdom)

Tập 28 Số 1

54-60

Thông tin tác giả