Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
BMJ Open. 2020 Jun 23;10(6):e035486. doi: 10.1136/bmjopen-2019-035486.
Bleeding is a common problem during adult extracorporeal membranes oxygenation (ECMO) support, requiring blood transfusion for correction of volume depletion and coagulopathy. The goal of this study is to investigate the long-term outcomes for adults under support of ECMO with massive blood transfusion (MBT).
Retrospective nationwide cohort study.
Data were provided from Taiwan National Health Insurance Research Database (NHIRD).
Totally 2757 adult patients were identified to receive MBT (red blood cell ≥10 units) during ECMO support from 2000 to 2013 via Taiwan NHIRD.
The outcomes included in-hospital major complications/mortality, all-cause mortality, cardiovascular death, newly onset end-stage renal disease and respiratory failure during the follow-up period.
Patients with MBT had higher in-hospital mortality (65.6% vs 52.1%; OR 1.74; 95% CI 1.53 to 1.98) and all-cause mortality during the follow-up (47.0% vs 35.8%; HR 1.46; 95% CI 1.25 to 1.71) than those without MBT. Not only higher incidences of post ECMO sepsis, respiratory failure and acute kidney injury, but also longer duration of ECMO support, ventilator use and intensive care unit stay were demonstrated in the MBT group. Moreover, a subdistribution hazard model presented higher cumulative of respiratory failure (19.8% vs 16.2%; subdistribution HR 1.36; 95% CI 1.07 to 1.73) for the MBT cohort. Positive dose-dependent relationship was found between the amount of transfused red blood cell product and in-hospital mortality. In the MBT subgroup analysis for the impact of transfused ratio (fresh frozen plasma/packed red blood cell) on in-hospital mortality, ratio ≥1.0 had higher mortality.
Patients with MBT during ECMO support had worse long-term outcomes than non-MBT population. The transfused amount of red blood cell had positive dose-dependent effect on in-hospital mortality.
成人体外膜肺氧合（ECMO）支持期间出血是常见问题，需要输血以纠正容量不足和凝血功能障碍。本研究旨在探讨大量输血（MBT）支持下成人 ECMO 的长期预后。
回顾性全国队列研究。
数据来自台湾全民健康保险研究数据库（NHIRD）。
2000 年至 2013 年，通过台湾 NHIRD 共确定 2757 名成人患者在 ECMO 支持期间接受 MBT（红细胞≥10 单位）。
住院期间主要并发症/死亡率、全因死亡率、心血管死亡、随访期间新发终末期肾病和呼吸衰竭。
MBT 患者住院死亡率（65.6% vs 52.1%；OR 1.74；95%CI 1.53 至 1.98）和随访期间全因死亡率（47.0% vs 35.8%；HR 1.46；95%CI 1.25 至 1.71）均高于无 MBT 患者。MBT 组不仅 ECMO 后脓毒症、呼吸衰竭和急性肾损伤的发生率较高，而且 ECMO 支持、呼吸机使用和重症监护病房住院时间也较长。此外，亚分布风险模型显示，MBT 组呼吸衰竭的累积发生率更高（19.8% vs 16.2%；亚分布 HR 1.36；95%CI 1.07 至 1.73）。输注的红细胞产品量与住院死亡率之间存在正剂量依赖性关系。在 MBT 亚组分析中，输注比例（新鲜冷冻血浆/浓缩红细胞）对住院死亡率的影响，比值≥1.0 死亡率更高。
MBT 支持下的 ECMO 患者的长期预后较非 MBT 人群差。输注的红细胞量与住院死亡率之间存在正剂量依赖性关系。
