Early red blood cell transfusion burden, hemoglobin at first transfusion, and in-hospital mortality in patients supported with veno-arterial ECMO: a multicenter cohort study
Authors' conclusion
In adults receiving peripheral VA-ECMO, early RBC transfusion burden showed a graded association with in-hospital mortality, whereas lower first-transfusion Hb was a prognostic marker chiefly within the consistent-threshold phenotype.
Study context
- Population
- Adults aged ≥18 years initiating peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) at six Korean centers, January 2018 to March 20251,140 in adjusted primary analysis
- Participants
- 2,020 adults
- Exposure
- Day-1 red blood cell (RBC) dose 1-2, 3-4 or ≥5 units vs no day-1 transfusion
- Outcome
- In-hospital mortality by day-1 RBC dose (primary analysis, 24-h landmark cohort)
Methodological details24-h landmark cohort, modified Poisson regression
- 24-h landmark cohort
- Modified Poisson regression
Main finding
As reported in the abstract
In-hospital mortality by day-1 RBC dose
Adjusted relative risk (95% CI)
1-2 units vs 0
1.20(1.02–1.40)
3-4 units vs 0
1.37(1.17–1.59)
≥5 units vs 0
1.48(1.28–1.71)
Per 2-unit increase
1.08(1.05–1.11)
Observational data: associations, not effects.
Further findings
| Outcome | Adjusted RR (95% CI) | |
|---|---|---|
| In-hospital mortality per 2-unit increase over ECMO days 1-2 | 1.06 (1.04–1.08) | |
| In-hospital mortality per 1 g/dL decrease in first-transfusion Hb (transfused complete cases)1,043 transfused complete cases | 1.15 (1.10–1.20) | |
| In-hospital mortality per 1 g/dL decrease in first-transfusion Hb, by transfusion-pattern phenotype (subgroup)Consistent-threshold phenotype | 1.16 (1.10–1.22) | |
| In-hospital mortality per 1 g/dL decrease in first-transfusion Hb, by transfusion-pattern phenotype (subgroup)Variable-threshold phenotype | 1.02 (0.92–1.12) | |
| 0.512Adjusted relative risk (log scale) |
Original publication
Early red blood cell transfusion burden, hemoglobin at first transfusion, and in-hospital mortality in patients supported with veno-arterial ECMO: a multicenter cohort study. Ann Intensive Care. Published 25 July 2026. doi:10.
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