Cardiac arrest & resuscitation
Hemoglobin trends and transfusion practices after cardiac arrest: a cohort study
Authors' conclusion
Anemia is common after cardiac arrest, worsening in initial survivors. There is substantial variation in pre-transfusion hemoglobin levels, reflecting clinical equipoise. Clinical trials are needed to disentangle anemia as a driver versus a marker of outcomes, and test whether the risk is modifiable.
Study context
- Population
- Adults who survived the initial resuscitation after in-hospital or out-of-hospital cardiac arrest (resuscitation ongoing at hospital arrival) and had a hemoglobin value measuredmet inclusion criteria, of 2,634 cardiac arrests · out-of-hospital arrests 152 · in-hospital arrests 806
- Participants
- 958 adults
- Exposure
- Out-of-hospital arrests vs in-hospital arrests
- Out-of-hospital arrestsn = 152
- In-hospital arrestsn = 806
- Outcome
- Initial post-arrest hemoglobin
Methodological detailsconsecutive adult cardiac arrests, three academic hospitals
- Consecutive adult cardiac arrests
- Three academic hospitals
Main finding
As reported in the abstract
Mean initial post-arrest hemoglobin
9.75 g/dL
SD 2.60
Observational data: associations, not effects.
Further findings
In-hospital mortality by initial post-arrest hemoglobin (exploratory)
| Adjusted OR (95% CI) | P value | ||
|---|---|---|---|
| Initial post-arrest hemoglobin ≥ 9 g/dLLower in-hospital mortality · exploratory analysis | 0.62 (0.46–0.84) | P < 0.01 | |
| 0.512Adjusted odds ratio (log scale) |
Red cell transfusions · 30 days post-arrest
- Patients transfused
- 369 (38.5%)
- Total transfusions
- 1,238
- Highest proportion of patients transfused in the first 48 h
Pre-transfusion hemoglobin
- Mean pre-transfusion hemoglobin
- 6.96 g/dL (SD 1.06)
- Of transfusions, pre-transfusion hemoglobin < 7 g/dL
- 762 (61.6%)
- Of transfusions, pre-transfusion hemoglobin ≥ 7 g/dL
- 476 (38.4%)
Mortality by post-arrest hemoglobin through 30 days (time-varying analysis)
- L-shaped association with mortality; 95% of the total reduction in mortality hazard captured below 9.20 g/dL
- Exploratory analysis
Original publication
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