Restrictive Transfusion Practice in Adults Receiving Venovenous Extracorporeal Membrane Oxygenation: A Single-Center Experience

Andrew J Doyle; Carla Richardson; Barnaby Sanderson; Katie Wong; Duncan Wyncoll; Luigi Camporota; Nicholas A Barrett; Beverley J Hunt; Andrew Retter

doi:10.1097/CCE.0000000000000077

Restrictive Transfusion Practice in Adults Receiving Venovenous Extracorporeal Membrane Oxygenation: A Single-Center Experience

Crit Care Explor. 2020 Jan 29;2(1):e0077. doi: 10.1097/CCE.0000000000000077. eCollection 2020 Jan.

Authors

Andrew J Doyle¹, Carla Richardson², Barnaby Sanderson³, Katie Wong³, Duncan Wyncoll³, Luigi Camporota³, Nicholas A Barrett³, Beverley J Hunt¹, Andrew Retter³

Affiliations

¹ Department of Haematology, Guy's & St Thomas NHS Foundation Trust, London, United Kingdom.
² Department of Intensive Care, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, United Kingdom.
³ Department of Intensive Care, Guy's & St Thomas NHS Foundation Trust, London, United Kingdom.

Abstract

Objectives: Restrictive transfusion policies have been adopted in critical care, although these have not included patients receiving extracorporeal membrane oxygenation. We aimed to assess survival outcomes, adverse events related to RBC transfusion, and cost implications following a change from a "liberal" to a "restrictive" RBC transfusion practice in patients receiving extracorporeal membrane oxygenation.

Design: Retrospective observational study.

Setting: Single high-volume tertiary critical care department at a university hospital.

Patients: Patients 16 years old or greater receiving venovenous extracorporeal membrane oxygenation between 2011 and 2017 for more than 24 hours.

Interventions: None.

Measurements and main results: Clinical diagnoses, complications, outcomes, median hemoglobin, and hematocrit levels were obtained from patients' electronic records. All laboratory results for hemoglobin and hematocrit were included. RBC transfusions were obtained from prescription charts. We included 402 patients: 99 during a "liberal" transfusion practice (2011-2014)-when the target hemoglobin level was greater than 100 g/L; and 303 treated during a "restrictive" transfusion practice (2014-2017) when the target hemoglobin level was greater than 80 g/L. We found that survival outcomes did not change following the implementation of a "restrictive" transfusion policy. There was also a decrease in the extracorporeal blood flow rates with restrictive transfusion of 0.5 L/min. Nonsurvivors of venovenous extracorporeal membrane oxygenation had higher usage of RBC units following a change in transfusion practice. The restrictive strategy allowed a cost saving of £454 per patient.

Conclusions: These results suggest that the adoption of a more restrictive approach to RBC transfusion during venovenous extracorporeal membrane oxygenation is more cost-effective and associated with similar survival outcomes, than when compared with a more liberal approach.

Keywords: blood transfusion; extracorporeal membrane oxygenation; hemoglobin.