Major haemorrhage and blood product utilisation in patients receiving VA ECMO for cardiogenic shock: a multicentre observational study (OBLEX)
Authors' conclusion
Haemorrhagic complications differ in clinical subgroups and RBC transfusion exposure is by far higher than in other critically unwell populations. We identified ECPR and antiplatelet therapy as additional predictors.
Study context
- Population
- Patients receiving VA ECMO in 12 ECMO centres from 3 continents, 2019–2022
- Participants
- 545 patients · 12 centres
- Exposure
- ECPR vs cardiothoracic surgery (CTS) vs cardiogenic shock (CS)
- ECPRn = 149
- CTSn = 169
- CSn = 227
- Outcome
- Haemorrhagic complications, transfusion practice and anticoagulation (descriptive)
Methodological detailsinvestigator-initiated, longitudinal, multicentre
- Investigator-initiated
- Longitudinal
- Multicentre
Main finding
As reported in the abstract
Major haemorrhage
- Major haemorrhage events over 2796 days
- 406
- Patients with major haemorrhage
- 286 (52%)
- Patients receiving red blood cell (RBC) transfusions
- 88%
- RBC transfusion rate, units/day
- 1.27 (95% CI 1.22 - 1.31)
- Platelet transfusion rate highest in CTS, units/day
- 0.58 (95% CI 0.53-0.64)
- Haemoglobin prior to transfusion, g/L (IQR 73, 84); independent of subgroups
- 78
- Platelet count prior to transfusion, × 10^9/L (IQR 37, 85)
- 58
- Platelet count prior to transfusion on days with major haemorrhage, × 10^9/L (IQR 50, 104)
- 74
- Systemic anticoagulation started within first 24 h
- 83% (95% CI 80-87%)
- Anticoagulation within 24 h in CS
- 90% (CI 85-95%)
Observational data: associations, not effects.
Further findings
Independent baseline predictors of RBC transfusion
| IRR (95% CI) | ||
|---|---|---|
| ECPR | 1.50 (1.19–1.89) | |
| Prior antiplatelets | 1.43 (1.13–1.80) | |
| 0.512Incidence rate ratio (log scale) |
| Outcome | IRR (95% CI) | |
|---|---|---|
| Independent baseline predictors of RBC transfusionMyocarditis vs Myocardial infarct | 0.57 (0.37–0.89) | |
| Independent baseline predictors of RBC transfusionPulmonary embolism vs Myocardial infarct | 0.67 (0.45–1.00) | |
| 0.20.5125Incidence rate ratio (log scale) |
Hospital mortality
- Hospital mortality, whole cohort
- 46%
Original publication
Major haemorrhage and blood product utilisation in patients receiving VA ECMO for cardiogenic shock: a multicentre observational study (OBLEX). Crit Care. Published 11 March 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →