Lo Pinto Hugo, Allyn Jérôme, Persichini Romain, Bouchet Bruno, Brochier Gilbert, Martinet Olivier, Brulliard Caroline, Valance Dorothée, Delmas Benjamin, Braunberger Eric, Dangers Laurence, Allou Nicolas
1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France.
2 Établissement Français du Sang, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France.
Int J Artif Organs. 2018 Oct;41(10):644-652. doi: 10.1177/0391398818785132. Epub 2018 Jul 12.
Few data are available on the potential benefits and risks of red blood cell transfusion in patients undergoing extracorporeal membrane oxygenation. The aim of this study was to identify the determinants and prognosis of red blood cell transfusion in patients undergoing extracorporeal membrane oxygenation, with a special focus on biological parameters during extracorporeal membrane oxygenation treatment.
We conducted a single-center retrospective cohort study including all consecutive patients who underwent extracorporeal membrane oxygenation between January 2010 and December 2015.
The 201 evaluated patients received a median of 0.9 [0.5-1.7] units of red blood cell per day. Significant and clinically relevant variables that best correlated with units of red blood cell transfused per day of extracorporeal membrane oxygenation were lower median daily prothrombin time in percentage (Quick) ( t = -0.016, p < 0.0001), higher median daily free bilirubin level ( t = 0.016, p < 0.0001), and lower pH ( t = -2.434, p < 0.0001). In multivariate analysis, red blood cell transfusion was associated with a significantly higher rate of in-intensive care unit mortality (per red blood cell unit increment; adjusted odds ratio: 1.07, 95% confidence interval: 1.02-1.12, p = 0.005). It was also associated with higher rates of acute renal failure ( p = 0.025), thromboembolic complications ( p = 0.0045), and sepsis ( p = 0.015).
This study suggests that red blood cell transfusion may be associated with a higher mortality rate and with severe complications. However, we cannot conclude a direct causal relationship, as red blood cell transfusion may be only a marker of poor outcome. We recommend that physicians correct acidosis and hemolysis in patients undergoing extracorporeal membrane oxygenation whenever possible.
关于体外膜肺氧合（ECMO）患者红细胞输血的潜在益处和风险，可用数据较少。本研究的目的是确定ECMO患者红细胞输血的决定因素和预后，特别关注ECMO治疗期间的生物学参数。
我们进行了一项单中心回顾性队列研究，纳入了2010年1月至2015年12月期间所有连续接受ECMO治疗的患者。
201例评估患者每天接受红细胞的中位数为0.9[0.5 - 1.7]单位。与ECMO每日红细胞输注单位最密切相关的显著且具有临床意义的变量包括较低的每日凝血酶原时间中位数百分比（Quick）（t = -0.016，p < 0.0001）、较高的每日游离胆红素水平中位数（t = 0.016，p < 0.0001）和较低的pH值（t = -2.434，p < 0.0001）。在多变量分析中，红细胞输血与重症监护病房死亡率显著升高相关（每增加一个红细胞单位；调整后的优势比：1.07，95%置信区间：1.02 - 1.12，p = 0.005）。它还与急性肾衰竭发生率较高（p = 0.025）、血栓栓塞并发症（p = 0.0045）和脓毒症（p = 0.015）相关。
本研究表明，红细胞输血可能与较高的死亡率和严重并发症相关。然而，我们不能得出直接的因果关系，因为红细胞输血可能只是不良预后的一个标志。我们建议医生在可能的情况下纠正接受ECMO治疗患者的酸中毒和溶血。
