Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA.
University of Virginia School of Medicine, Charlottesville, Virginia, USA.
Transfusion. 2024 Mar;64(3):475-482. doi: 10.1111/trf.17729. Epub 2024 Feb 22.
Adult extracorporeal membrane oxygenation (ECMO) patients are at high risk for allogeneic blood transfusion. Few studies have characterized iatrogenic blood loss from phlebotomy in adult ECMO patients. We hypothesized that iatrogenic phlebotomy would be a significant source of blood loss during ECMO.
Adults who had their entire ECMO run at our medical center between 2020 and 2022 were included. Average daily phlebotomy volume and total phlebotomy volume during ECMO were estimated based on the total number of laboratory tests that were processed. In addition, the crude and adjusted association between total phlebotomy volume during ECMO and RBC transfusion during ECMO was evaluated using linear regression and Loess curve analysis.
A total of 161 patients who underwent 162 ECMO runs were included. Of the 162 ECMO runs, 88 (54.3%) were veno-arterial and 74 (45.7%) were veno-venous ECMO. Median duration of ECMO was 5 days [25th, 75th percentile = 2, 11]. Median daily phlebotomy volume was 130 mLs [25th, 75th percentile = 94, 170] and median total phlebotomy volume during ECMO was 579 mLs [25th, 75th percentile = 238, 1314]. There was a significant crude and adjusted association between total phlebotomy volume and RBC transfusion during ECMO (beta coefficient = 0.0023 and 0.0024 respectively, both p < .001) based on linear regression analysis.
Phlebotomy for laboratory testing is a significant source of blood loss during ECMO in adults. Comprehensive patient blood management for adult ECMO patients should include strategies to reduce laboratory testing and/or phlebotomy volume during ECMO.
成人体外膜肺氧合（ECMO）患者有大量异体输血的风险。很少有研究描述成人 ECMO 患者因采血造成的医源性失血。我们假设 ECMO 期间采血会导致大量失血。
纳入 2020 年至 2022 年期间在我们医疗中心进行整个 ECMO 运行的成年人。根据处理的实验室检测总数，估计 ECMO 期间的平均每日采血量和 ECMO 期间的总采血量。此外，使用线性回归和 Loess 曲线分析评估 ECMO 期间总采血量与 ECMO 期间 RBC 输血之间的粗关联和调整关联。
共纳入 161 名接受 162 次 ECMO 运行的患者。162 次 ECMO 运行中，88 次（54.3%）为静脉-动脉 ECMO，74 次（45.7%）为静脉-静脉 ECMO。ECMO 的中位持续时间为 5 天[25 百分位，75 百分位=2，11]。中位每日采血量为 130mLs[25 百分位，75 百分位=94，170]，ECMO 期间总采血量中位数为 579mLs[25 百分位，75 百分位=238，1314]。线性回归分析显示，ECMO 期间总采血量与 RBC 输血之间存在显著的粗关联和调整关联（β系数分别为 0.0023 和 0.0024，均 P<0.001）。
实验室检测采血是成人 ECMO 期间失血的重要来源。成人 ECMO 患者的综合患者血液管理应包括减少 ECMO 期间实验室检测和/或采血量的策略。
