Grazioli Alison, Plazak Michael, Dahi Siamak, Rabin Joseph, Menne Ashley, Ghoreishi Mehrdad, Taylor Bradley, Perelman Seth, Mazzeffi Michael
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA.
Perfusion. 2023 Oct;38(7):1519-1525. doi: 10.1177/02676591221119015. Epub 2022 Aug 11.
It remains unclear whether patients who will not accept allogeneic blood transfusion can be managed successfully with veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO). The objective of our study was to determine what percentage of V-A ECMO patients were managed without allogeneic blood transfusion.
This was a retrospective, observational cohort study of patients with cardiogenic shock requiring V-A ECMO between January 2016 and January 2019. The primary outcome was avoidance of any allogeneic blood transfusion.
Of the 206 patients included, 23 (11.2%) were managed without any allogeneic blood transfusion. Fourteen (60.9%) avoided allogeneic blood transfusion during their entire hospitalization. "No-transfusion" patients were younger, more commonly men, were less likely to have a prior diagnosis of hypertension or coronary artery disease, had higher baseline hemoglobin, had higher SAVE scores, and were less likely to have received aspirin before ECMO. No patients in the "no-transfusion" group had major bleeding compared to 35% of patients in the blood transfusion group ( < 0.001). In-hospital mortality was 17.4% for those who avoided blood transfusion and 41.5% for those who received blood transfusion ( = 0.04). ECMO duration was significantly shorter in patients who avoided blood transfusion compared to those who received blood transfusion (median 3.5 vs 7 days, < 0.001).
Select patients can be successfully managed on V-A ECMO without allogeneic blood transfusion. Jehovah's Witnesses and other patients with objections to allogeneic transfusion might be offered V-A ECMO if its anticipated duration is short (e.g. <7 days) and baseline hemoglobin concentration is high (e.g. ≥10 mg/dL).
对于那些不接受异体输血的患者，是否能够通过静脉-动脉（V-A）体外膜肺氧合（ECMO）成功治疗仍不明确。我们研究的目的是确定V-A ECMO患者中不接受异体输血治疗的比例。
这是一项对2016年1月至2019年1月期间因心源性休克需要V-A ECMO治疗的患者进行的回顾性观察队列研究。主要结局是避免任何异体输血。
纳入的206例患者中，23例（11.2%）未接受任何异体输血治疗。14例（60.9%）在整个住院期间避免了异体输血。“未输血”患者更年轻，男性更为常见，既往诊断为高血压或冠状动脉疾病的可能性较小，基线血红蛋白水平较高，SAVE评分较高，且在ECMO治疗前接受阿司匹林治疗的可能性较小。“未输血”组无患者发生大出血，而输血组这一比例为35%（<0.001）。避免输血患者的院内死亡率为17.4%，输血患者为41.5%（P = 0.04）。与输血患者相比，避免输血患者的ECMO持续时间明显更短（中位数3.5天对7天，P < 0.001）。
部分患者可在不进行异体输血的情况下通过V-A ECMO成功治疗。如果预计持续时间较短（如<7天）且基线血红蛋白浓度较高（如≥10mg/dL），耶和华见证会信徒及其他反对异体输血的患者可能适合接受V-A ECMO治疗。
