Martucci Gennaro, Grasselli Giacomo, Tanaka Kenichi, Tuzzolino Fabio, Panarello Giovanna, Schmidt Matthieu, Bellani Giacomo, Arcadipane Antonio
1 Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
2 Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy.
Perfusion. 2019 Apr;34(1_suppl):39-48. doi: 10.1177/0267659119830526.
Optimal red blood cell transfusion practice during veno-venous extracorporeal membrane oxygenation (VV ECMO) is still under debate. This survey aimed to assess the Hb trigger (also comparing with other critically ill patients) and major physiologic determinants considered for transfusions during veno-venous extracorporeal membrane oxygenation.
Voluntary Web-based survey, endorsed by the European Society of Intensive Care Medicine, conducted among VV ECMO pratictioners worldwide.
A total of 447 respondents worldwide answered the questionnaire: 277 (61.9%) from Europe, 99 (22.1%) from North America, 36 (8.2%) from Asia and Oceania, and 35 (7.8%) from Central and South America. Among the respondents, 59.2% managed less than 12 venous extracorporeal membrane oxygenation runs/year, 19.4% between 12 and 24 runs/year, and 21.4% more than 24 runs/year. Of the respondents, 54.4% do not use a predefined Hb trigger in veno-venous extracorporeal membrane oxygenation, and, while the rate of adoption of a defined trigger varied worldwide, the effective value of Hb did not differ significantly among macro-regions. In patients on veno-venous extracorporeal membrane oxygenation, the Hb trigger to initiate red blood cell transfusion, was higher than in other critically ill patients: 9.1 ± 1.8 g/dL versus 8.3 ± 1.7 g/dL, p < 0.01. The Hb trigger was lower in centers with more than 24 venous extracorporeal membrane oxygenation runs/year (8.4 mg/dL (95% CI: 7.7-8.9)); (8.9 mg/dL (95% CI: 8.2-9.7)) in centers with between 12 and 24 venous extracorporeal membrane oxygenation runs/year; and (9.6 mg/dL (95% CI: 9.1-10.0)) in centers with fewer than 12 venous extracorporeal membrane oxygenation runs/year (p < 0.01). Several and variable adjunctive parameters are considered in cases of uncertainty for transfusion: the principal are hemodynamic status, SvO2, lactates, and fluid balance.
Although the use of a predefined Hb trigger is still under-adopted among centers with low or median extracorporeal membrane oxygenation case volume, the majority of respondents use a higher Hb trigger for veno-venous extracorporeal membrane oxygenation patients compared with other critically ill patients. Higher volume centers tolerate lower Hb levels.
静脉-静脉体外膜肺氧合（VV ECMO）期间的最佳红细胞输血实践仍存在争议。本调查旨在评估血红蛋白触发值（并与其他危重症患者进行比较）以及静脉-静脉体外膜肺氧合期间输血时考虑的主要生理决定因素。
在欧洲重症监护医学学会认可下，开展基于网络的自愿性调查，调查对象为全球范围内的VV ECMO从业者。
全球共有447名受访者回答了问卷：277名（61.9%）来自欧洲，99名（22.1%）来自北美，36名（8.2%）来自亚洲和大洋洲，35名（7.8%）来自中美洲和南美洲。在受访者中，59.2%每年管理的静脉体外膜肺氧合运行次数少于12次，19.4%为每年12至24次，21.4%超过24次。在受访者中，54.4%在静脉-静脉体外膜肺氧合中未使用预定义的血红蛋白触发值，虽然采用特定触发值的比例在全球范围内有所不同，但血红蛋白的有效数值在各大区域之间无显著差异。在接受静脉-静脉体外膜肺氧合的患者中，启动红细胞输血的血红蛋白触发值高于其他危重症患者：分别为9.1±1.8 g/dL和8.3±1.7 g/dL，p<0.01。每年静脉体外膜肺氧合运行次数超过24次的中心，其血红蛋白触发值较低（8.4 mg/dL（95%CI：7.7 - 8.9））；每年静脉体外膜肺氧合运行次数在12至24次之间的中心为（8.9 mg/dL（95%CI：8.2 - 9.
