Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Perfusion. 2022 May;37(4):377-384. doi: 10.1177/0267659121998944. Epub 2021 Mar 3.
Extracorporeal membrane oxygenation (ECMO) is a rescue procedure used for cardiac and pulmonary dysfunction. Patients on ECMO often require blood transfusions to maintain oxygen delivery and recover from bleeding complications. Goals of the current study were to determine transfusion requirements while on ECMO, and incidence and transfusion requirements for bleeding complications.
Packed red blood cell (PRBC) transfusions and bleeding complications were identified by retrospective chart review of patients on ECMO from 2010 to 2018 at our institution. Patients were categorized into those who did not bleed (group A) and those who bled (group B). Incidence, sites of bleed, and transfusion requirement for each bleeding were analyzed.
Among 217 patients including veno-arterial (VA) ( = 148) and veno-venous (VV) ( = 69) ECMO, we identified 62 patients without bleeding complications (group A) and 155 patients with bleeding complications (group B). In group A, transfusion requirement was 0.6 PRBC/day for VA-ECMO ( = 42) and 0.2 PRBC/day for VV-ECMO ( = 20) (p = 0.0015). In group B, number of PRBC given per event per day for bleeding complications during ECMO was mediastinal/thoracic bleed (83 events, 4.7 PRBC/event/day), gastrointestinal bleed (59 events, 4.8 PRBC/event/day), cannulation site bleed (88 events, 3.6 PRBC/event/day), and nasopharyngeal bleed (103 events, 2.8 PRBC/event/day). Thirty-day hospital mortality rate was co-related to transfusion requirement (area under ROC curve: 0.70).
Patients without clinical bleeding still required transfusion, with higher rates observed with VA- than VV-ECMO. Transfusion requirements dramatically increased when patients developed various bleeding complications and had a significant impact on 30-day mortality rate.
体外膜肺氧合（ECMO）是一种用于治疗心、肺功能障碍的抢救程序。接受 ECMO 的患者常需要输血以维持氧输送并从出血并发症中恢复。本研究的目的是确定 ECMO 期间的输血需求，以及出血并发症的发生率和输血需求。
通过回顾性分析我院 2010 年至 2018 年期间接受 ECMO 的患者的病历，确定接受输血的患者（接受输血组，A 组）和发生出血并发症的患者（出血组，B 组）。分析出血并发症的发生率、出血部位和输血需求。
在 217 例患者中，包括静脉-动脉（VA）（ = 148）和静脉-静脉（VV）（ = 69）ECMO，我们发现 62 例无出血并发症的患者（A 组）和 155 例有出血并发症的患者（B 组）。在 A 组中，VA-ECMO 的输血需求为 0.6 PRBC/天（ = 42），VV-ECMO 的输血需求为 0.2 PRBC/天（ = 20）（p = 0.0015）。在 B 组中，ECMO 期间每个出血事件的每日 PRBC 输注量为纵隔/胸部出血（83 个事件，4.7 PRBC/事件/天）、胃肠道出血（59 个事件，4.8 PRBC/事件/天）、置管部位出血（88 个事件，3.6 PRBC/事件/天）和鼻咽部出血（103 个事件，2.8 PRBC/事件/天）。30 天住院死亡率与输血需求相关（ROC 曲线下面积：0.70）。
无临床出血的患者仍需要输血，VA-ECMO 患者的输血率高于 VV-ECMO。当患者发生各种出血并发症时，输血需求显著增加，并对 30 天死亡率有显著影响。
