Aims & Objectives:
Patients supported with Extracorporeal Membrane Oxygenation (ECMO) receive large volumes of red blood cell (RBC) transfusions. We aimed to describe survival and factors associated with large RBC transfusion volume during pediatric ECMO.
This retrospective single-center cohort study included all patients supported by ECMO for > 12 hours from January 1st, 2015 through December 31st, 2016. The primary outcome was RBC volume transfused during ECMO (ml/kg/day).
123 patients with median age of 0.3 (Interquartile range [IQR]: 0, 3) years were analyzed. Congenital heart disease (CHD; n=56, 46%) was the most common diagnosis. Median RBC volume transfused during ECMO was 26 (IQR 12, 46) ml/kg/day. Higher volumes were transfused during the first 24 hours (figure 1). High RBC users (>75th percentile) were more likely be supported by veno-arterial ECMO (100 vs 75%, p=0.005), have CHD (81 vs 34%, p < 0.001), and experience bleeding (33 vs 11% days, p<0.001). In multivariable linear regression analysis younger age (-7% per year, 95%Confidence Interval [CI] -9 to -5%, p<0.001), CHD (+36%, 95%CI 4–78%, p=0.03), extracorporeal cardiopulmonary resuscitation (+54%, 95%CI 18–100%, p=0.002), more blood draws per day (+6%, 95%CI 3–9%, p<0.001), and higher proportion of bleeding days (+30% per 10% increase, 95%CI 21–39%, p<0.001) were associated with larger RBC transfusion volume. Mortality was higher in those receiving large RBC transfusion volume (61 vs 36%, p=0.02)
ECMO patients exposed to large RBC transfusion volume have reduced survival. The association of bleeding and frequent laboratory testing with higher transfusion volume offers quality improvement opportunities in ECMO management.