From the Departments of Pathology and Laboratory Medicine-Transfusion Medicine/Blood Bank Division.
Surgery-Cardiac Surgery Division.
Anesth Analg. 2018 Apr;126(4):1262-1267. doi: 10.1213/ANE.0000000000002238.
Extracorporeal membrane oxygenation supplies oxygenated blood to the body supporting the heart and lungs. Survival rates of 20% to 50% are reported among patients receiving ECMO for cardiac arrest, severe cardiogenic shock, or failure to wean from cardiopulmonary bypass following cardiac surgery. Bleeding is one of the most common complications in ECMO patients due to coagulopathy, systemic anticoagulation, and the presence of large bore cannulas at systemic pressure. Absence of a standardized transfusion protocol in this population leads to inconsistent transfusion practices. Here, we assess a newly developed dedicated transfusion protocol in this clinical setting.
Data were retrospectively reviewed for the first 30 consecutive cardiac ECMO patients prior and post implementation of the ECMO transfusion protocol. Diagnoses, laboratory results, blood component utilization, and outcomes were collected and analyzed.
Comorbidities were similar between the 2 eras, as well as the pre-ECMO ejection fraction (P = .568) and duration on ECMO (P = .278). Transfusion utilization data revealed statistically significant decreases in almost all blood components and a savings in blood component acquisition costs of 51% ($175, 970). In addition, an almost 2-fold increase in survival rate was observed in the post-ECMO transfusion protocol era (63% vs 33%; relative risk = 1.82; 95% confidence interval, 1.07-3.10; P = .028).
Our data indicate that implementation of a standardized transfusion protocol, using more restrictive transfusion indications in cardiac ECMO patients, was associated with reduced blood product utilization, decreased complications, and improved survival. This multidepartmental approach facilitates better communication and adherence to consensus clinical decision making between intensive care unit, surgery, and transfusion service and optimizes care of complicated and acutely ill patients.
体外膜肺氧合 (ECMO) 将充氧的血液输送到体内，为心脏和肺部提供支持。在因心脏骤停、严重心源性休克或心脏手术后心肺旁路无法脱机而接受 ECMO 的患者中，报告的存活率为 20%至 50%。由于凝血功能障碍、全身抗凝和存在大口径插管处于全身压力下，出血是 ECMO 患者最常见的并发症之一。由于缺乏针对该人群的标准化输血方案，导致输血实践不一致。在这里，我们评估了该临床环境中一个新开发的专用输血方案。
回顾性分析了实施 ECMO 输血方案前后的前 30 例连续心脏 ECMO 患者的数据。收集并分析了诊断、实验室结果、血液成分利用情况和结局。
两个时期的合并症相似，ECMO 前的射血分数 (P =.568) 和 ECMO 持续时间 (P =.278) 也相似。输血利用数据显示，几乎所有血液成分的使用都显著减少，血液成分获取成本节省了 51%（$175,970）。此外，在 ECMO 后输血方案时期，观察到生存率几乎翻了一番（63%比 33%；相对风险 = 1.82；95%置信区间，1.07-3.10；P =.028）。
我们的数据表明，在心脏 ECMO 患者中实施标准化输血方案，使用更严格的输血指征，与减少血液制品的使用、减少并发症和提高生存率相关。这种多部门方法促进了重症监护病房、外科和输血服务之间更好的沟通和对共识临床决策的遵守，并优化了对复杂和急性疾病患者的护理。
