Transfusion practice in patients receiving VV extracorporeal membrane oxygenation (ECMO) (PROTECMO): a prospective, multicentre, observational study
Authors' conclusion
During VV ECMO, there was no universally accepted threshold for transfusion, but PRBC transfusion was invariably associated with lower mortality only when done with haemoglobin concentration of less than 7 g/dL.
Study context
- Population
- Consecutive adults with acute respiratory distress syndrome (ARDS) receiving VV ECMO, 41 ECMO centres in Europe, North America, Asia, and Australia7,944 ECMO days
- Participants
- 604 adults
- Outcome
- Daily haemoglobin concentration, haemoglobin at PRBC transfusion, and rate of transfusions
Methodological detailsmulticentre, observational, marginal structural models with inverse probability weighting
- Multicentre
- Observational
- Marginal structural models with inverse probability weighting
Main finding
As reported in the abstract
Mean haemoglobin concentration over ECMO days (SD 1.2), lower in North America and high-volume centres
9.1 g/dL
Days on ECMO with packed red blood cell (PRBC) transfusion
2432
31%
Patients receiving at least one PRBC unit
504
83%
Mean pretransfusion haemoglobin concentration (SD 1.1), varied by clinical rationale
8.1 g/dL
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| ICU death, haemoglobin <7 g/dL vs higher concentrations (time-dependent Cox model) | 2.99 (1.95–4.60) | |
| 0.20.5125Hazard ratio (log scale) |
ICU death, PRBC transfusion at haemoglobin <7 g/dL
| HR (CI) | ||
|---|---|---|
| PRBC transfusion | 0.15 (0.03–0.74) | |
| 0.050.21520Hazard ratio (log scale) |
- No significant effect on mortality of transfusion at haemoglobin 7.0-7.9, 8.0-9.9 or >10 g/dL
Original publication
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