Liberal or restrictive transfusion for veno-arterial extracorporeal membrane oxygenation patients: a target trial emulation using the OBLEX study data
Authors' conclusion
This target trial emulation study suggests that a liberal transfusion threshold may provide a modest survival benefit during the early course of VA-ECMO, but no benefit afterwards.
Study context
- Population
- Patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO), 12 centres in Australia, Europe and North America, 2019–2022 (OBLEX study)
- Participants
- 534 patients · 12 centres
- Exposure
- Liberal vs restrictive transfusion practice
- Outcome
- Hospital mortality
- Follow-up
- Within seven days of ECMO initiation
Methodological detailssequential trials approach, international, multicentre
- Sequential trials approach
- International
- Multicentre
Main finding
As reported in the abstract
Survival probability
Liberal vs RestrictiveDifference in survival probabilities (95% CI)
Day 2; NNT 8
12%(3%–21%)
Day 3; NNT 7
13%(2%–25%)
Observational data: associations, not effects.
Further findings
In-hospital mortality, whole cohort
- Died during hospitalisation
- 46%
Sensitivity and exploratory analyses
- Results consistent across sensitivity and exploratory analyses
Original publication
Liberal or restrictive transfusion for veno-arterial extracorporeal membrane oxygenation patients: a target trial emulation using the OBLEX study data. Crit Care. Published 18 August 2025. doi:10.
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