In the general critical care patient population, restrictive transfusion regimen of RBCs has been shown to be safe and is yet implemented worldwide. However, in patients on venovenous extracorporeal membrane oxygenation, guidelines suggest liberal thresholds, and a clear overview of RBC transfusion practice is lacking. This study aims to create an overview of RBC transfusion in venovenous extracorporeal membrane oxygenation.DESIGN: Mixed method approach combining multicenter retrospective study and survey.

Background/Objectives: The increasing complexity of patients undergoing cardiac surgery requires extended myocardial ischaemic periods. Cardiac surgeons demand a cardioplegic solution with prolonged myocardial protection. Therefore, we introduced Custodiol in our centre in 2011. The aim of this study was to investigate the safety and efficacy of Custodiol compared with the standard method of cardioplegia. Methods: Between 2011 and 2016, 188 adult patients who underwent mitral valve surgery combined with coronary artery bypass grafting were included in this retrospective study. In 113 patients, Custodiol cardioplegia was used to achieve cardiac arrest, while St. Thomas Hospital solution was used in 75 patients. The primary endpoint of the study was the degree myocardial damage which was estimated by the measurement of creatine kinase-myocardial band on the first postoperative day. A linear regression analysis was performed to compare the aortic cross-clamp time with the postoperative myocardial damage in both groups. Results: The extracorporeal circulation time and aortic cross-clamp were significantly longer in the Custodiol group than in the St. Thomas group: 125.6 ± 32.5 minutes versus 93.1 ± 27.7 minutes (p < 0.001), respectively. However, there was no significant difference between the two groups regarding the postoperative levels of creatine kinase-myocardial band (96 (70-140) U/L vs. 86 (69-120) U/L, respectively; p = 0.321). There was no significant differences between the two groups regarding the 30-day mortality (6.1% vs. 5.5%, respectively; p = 1.000) or 120-day mortality (9.6% vs. 11.0%, respectively; p = 0.806). Conclusion: Our findings demonstrate that Custodiol is a safe method of myocardial protection for patients who underwent mitral valve surgery with coronary artery bypass grafting in our hospital. Further investigations extended to more cardiac surgery populations are needed to confirm clinical benefits of Custodiol cardioplegia.

Objective Veno-Arterial Extra Corporeal Life Support (VA ECLS) is widely used as an effective device for patients in cardiogenic shock. The need for predictive markers that daily guide physicians in the evaluation of these patients could be of great value. Our aim was to investigate the role of cholesterol value during VA ECLS in predicting the Intensive Care Unit (ICU) survival. Methods Between January 2013 and November 2019, 67 patients with VA ECLS due to cardiogenic shock were included in this study. Demographic data, laboratory values, ICU data and outcomes were collected. Cholesterol was measured during morning routine blood samples. The minimal cholesterol value during the ICU stay was registered. Groups were stratified by minimal cholesterol cut-off point of 2.0 mmol/L. Logistic regression analysis were performed to identify variables associated with ICU survival. Results The ECLS duration was not significantly different (p=0.36) between the non-survivors (median 5.0 (2.0-7.5) days) and survivors (median 6.0 (1.8-12.0) days). The minimal cholesterol level was significantly lower (p=0.04) in non-survivors group (1.54 (1.00-1.87) mmol/L) compared to survivors (1.85 (1.38-2.24) mmol/L). By using logistic regression analysis, minimal cholesterol level of ≥2.0 mmol/L was associated with a higher ICU survival (p=0.02; OR 3.77; 95% CI 1.20-11.81). Conclusion Cholesterol level could be an additional marker for ICU survival of patients with cardiogenic shock on VA ECLS. A larger cohort of patients is necessary to determine total cholesterol as a specific risk factor for survival in these patients.

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