Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Transfusion. 2023 May;63(5):942-951. doi: 10.1111/trf.17317. Epub 2023 Mar 31.
Low cerebral regional tissue oxygenation (crSO2) is associated with unfavorable neurological outcomes in children requiring extracorporeal membrane oxygenation (ECMO) support. Red blood cell (RBC) transfusion can improve brain oxygenation and crSO2 has been proposed as a noninvasive monitoring tool that could aid in RBC transfusion decision-making. However, how crSO2 responds to RBC transfusion is largely unknown.
This was a retrospective, observational cohort study of all patients <21 years supported on ECMO at a single institution from 2011 to 2018. Transfusion events were grouped by pre-transfusion hemoglobin concentration (<10, 10- < 12, and ≥ 12 g/dL). Post- versus pre-transfusion crSO2 changes were analyzed using linear mixed-effects models.
The final cohort included 830 transfusion events in 111 patients. Hemoglobin increased significantly post- versus pre-RBC transfusion (estimated mean increase of 0.47 g/dL [95% CI, 0.35-0.58], p < .001), as did crSO2 (estimated mean increase of 1.82 percentage points [95% CI, 1.23-2.40], p < .001). Larger improvements in crSO2 were associated with lower pre-transfusion crSO2 values (p < .001). There was no difference in mean change in crSO2 across the three hemoglobin groups in unadjusted analysis (p = .5) or after adjusting for age, diagnostic category, and pre-transfusion rSO2 (p = .15). Pre-transfusion crSO2 was <50% for 112 of 830 (13.5%) transfusion events, with only 30 (26.8%) crSO2 measurements noted to increase ≥50% post-transfusion.
Among neonatal and pediatric patients on ECMO support, there was a statistically significant increase in crSO2 following RBC transfusion, although clinical significance needs to be investigated further. The effect was strongest among patients with lower crSO2 pre-transfusion.
在需要体外膜肺氧合 (ECMO) 支持的儿童中，脑局部组织氧合（crSO2）水平低与不良神经结局相关。红细胞（RBC）输注可以改善脑氧合，crSO2 已被提议作为一种非侵入性监测工具，可辅助 RBC 输注决策。然而，crSO2 对 RBC 输注的反应如何在很大程度上尚不清楚。
这是一项对 2011 年至 2018 年期间在一家机构接受 ECMO 支持的所有<21 岁患者的回顾性、观察性队列研究。根据输注前血红蛋白浓度（<10、10-<12 和≥12 g/dL）将输注事件分为不同组。使用线性混合效应模型分析输注前后 crSO2 的变化。
最终纳入了 111 名患者的 830 次输血事件。与 RBC 输注前相比，血红蛋白明显增加（估计平均增加 0.47 g/dL [95%CI，0.35-0.58]，p<0.001），crSO2 也增加（估计平均增加 1.82 个百分点 [95%CI，1.23-2.40]，p<0.001）。crSO2 的较大改善与较低的输注前 crSO2 值相关（p<0.001）。在未调整分析（p=0.5）或调整年龄、诊断类别和输注前 rSO2 后（p=0.15），血红蛋白三组间 crSO2 的平均变化无差异。在 830 次输血事件中，有 112 次（13.5%）输血前 crSO2<50%，只有 30 次（26.8%）输血后 crSO2 测量值增加≥50%。
在接受 ECMO 支持的新生儿和儿科患者中，RBC 输注后 crSO2 呈统计学显著增加，但需要进一步研究其临床意义。该效应在输注前 crSO2 较低的患者中最强。
