Blood Transfusion Requirements for Patients on Extracorporeal Membrane Oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) is a rescue device 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 are to determine: 1) transfusion requirements while on ECMO, 2) incidence of bleeding complications, 3) 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 and sites of bleeding were analyzed, and transfusion requirement for each bleeding event was determined. Among a total of 217 patients including veno-arterial (VA) (n=148) and veno-venous (VV) (n=69) ECMO, we identified 62 patients (29%) without bleeding complications (group A) and 155 patients (71%) with bleeding complications (group B). Overall PRBC transfusion requirement was significantly higher in group B (1.6 PRBC/day) than group A (0.5 PRBC/day) [p=<0.0001]. In group A, number of PRBC requirements was 0.6 PRBC/day for VA ECMO (n=42) and 0.2 PRBC/day for VV ECMO (n=20) [p=0.0015]. In group B, number of PRBC requirements was 1.8 PRBC/day for VA ECMO (n=106) and 1.1 PRBC/day for VV ECMO (n=49) [p=0.0006]. In group B, number of PRBC given per major bleeding complication during ECMO was: mediastinal/thoracic bleed (7.3 PRBC), GI bleed (7.1 PRBC), cannulation site bleed (5.2 PRBC), and ENT bleed (4.1 PRBC). Number of PRBC given per event per day for major bleeding complications during ECMO was: mediastinal/thoracic bleed (84events, 4.7 PRBC/event/day), GI bleed (59 events, 4.8 PRBC/event/day), cannula site bleed (88 events, 3.6 PRBC/event/day), and ENT bleed (103 events, 2.8 PRBC/event/day). 30-Day hospital survival rate after ECMO decannulation was higher in group A (71%) than group B (49%) [p=0.003]. Various bleeding complications were observed during ECMO. Transfusion requirements dramatically increased once patients developed bleeding complications. Patient outcomes were exacerbated by bleeding complications. ECMO patients without any clinical bleeding still required transfusion, which was higher in VA than VV ECMO.