Temple Fergal T, Simonova Gabriela, Passmore Margaret R, Foley Samuel R, Diab Sara D, Dunster Kimble R, McDonald Charles I, Shekar Kiran, Fung Yoke-Lin, Tung John-Paul, Fraser John F
Research and Development, Australian Red Cross Lifeblood, Brisbane, Australia.
Sydney Medical School, University of Sydney, Sydney, Australia.
Crit Care. 2025 Jun 13;29(1):240. doi: 10.1186/s13054-025-05438-z.
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is associated with a high transfusion burden. While trials have concluded that red blood cell (RBC) storage does not impact patient morbidity and mortality in the critically ill or cardiac surgical cohorts, evidence is sparse for ECMO cohorts. A sheep model was to investigate this question. On an underlying injury of smoke inhalation, we compared fresh (< 5 days) or stored (35-42 days) RBC transfusion with no transfusion. Clinically relevant outcomes included pulmonary artery pressure as well as biochemical or histopathological markers of lung, liver, and renal injury.
Twenty-four female Merino/Samm Border Leicester Cross sheep were anaesthetised and placed on pressure-controlled ventilation. They were instrumented for continuous haemodynamic monitoring. They then underwent smoke inhalation injury, followed two hours later by veno-venous ECMO. Sheep were randomised to three groups: control (no transfusion (n = 8)), fresh RBC (n = 8) and stored RBC (n = 8) transfusion occurring six hours after ECMO initiation. Blood samples were taken regularly, and 24 h post-ECMO, animals were sacrificed. Post-mortem samples of lung and kidney were collected for post-mortem analyses.
Following ECMO initiation and transfusion, pulmonary artery pressure increased in the stored RBC group. Histopathological analysis also demonstrated a significantly elevated lung injury in this group. This lung injury was characterised by greater extravasation of inflammatory cells as well as bronchiole damage and oedema. Renal histopathology showed no significant differences between groups. Alanine aminotransferase, aspartate aminotransferase and bilirubin levels increased in a time dependent manner post-transfusion but there were no treatment-associated differences. During experimentation, the coagulation profile changed with firmer clots forming more quickly. Differences were observed between both transfusion groups and controls.
Transfusion of stored RBC elevated pulmonary artery pressure when compared to fresh RBC transfusion and controls. This change was correlated with a greater post-transfusion lung injury in the stored RBC group. Further investigation assessing whether insufficient nitric oxide had a role in these findings is warranted, as is consideration of longer ECMO durations and greater transfusion volumes.
静脉-静脉体外膜肺氧合（VV-ECMO）与高输血负担相关。虽然试验得出结论，红细胞（RBC）储存对重症患者或心脏手术队列中的患者发病率和死亡率没有影响，但针对ECMO队列的证据却很少。本研究采用绵羊模型来探讨这个问题。在烟雾吸入所致的基础损伤上，我们比较了新鲜（<5天）或储存（35 - 42天）红细胞输血与不输血的情况。临床相关结局包括肺动脉压以及肺、肝和肾损伤的生化或组织病理学标志物。
24只雌性美利奴/萨米边境莱斯特杂交绵羊麻醉后置于压力控制通气下。对其进行连续血流动力学监测。然后它们接受烟雾吸入损伤，两小时后进行静脉-静脉ECMO。绵羊被随机分为三组：对照组（不输血（n = 8））、新鲜红细胞组（n = 8）和储存红细胞组（n = 8），在ECMO启动后6小时进行输血。定期采集血样，ECMO治疗24小时后，处死动物。采集肺和肾的尸检样本进行尸检分析。
在启动ECMO并输血后，储存红细胞组的肺动脉压升高。组织病理学分析还显示该组肺损伤明显加重。这种肺损伤的特征是炎症细胞渗出增多以及细支气管损伤和水肿。肾组织病理学在各组之间无显著差异。输血后丙氨酸转氨酶、天冬氨酸转氨酶和胆红素水平呈时间依赖性升高，但无治疗相关差异。在实验过程中，凝血情况发生变化，形成更坚实的凝块更快。在两个输血组和对照组之间观察到差异。
与新鲜红细胞输血和对照组相比，储存红细胞输血会使肺动脉压升高。这种变化与储存红细胞组输血后更严重的肺损伤相关。有必要进一步研究评估一氧化氮不足是否在这些结果中起作用，同时也需要考虑更长的ECMO持续时间和更大的输血量。
