RBC Exposure in Pediatric Extracorporeal Membrane Oxygenation: Epidemiology and Factors Associated With Large Blood Transfusion Volume*

O’Halloran, Conor P.; Alexander, Peta; Andren, Kristofer; Mecklosky, Jessica; Salvin, Joshua W.; Larsen, Stephanie; Zalieckas, Jill M.; Fynn‐Thompson, Francis; Thiagarajan, Ravi R.

doi:10.1097/pcc.0000000000001596

Cited by 20 publications

(15 citation statements)

References 15 publications

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“…Patients often receive blood products to maintain hemoglobin and product targets on ECMO. [50][51][52] In the recent Pediatric Critical Care Transfusion and Anemia Expertise Initiative consensus statements regarding red blood cell transfusion in critical illness, there was insufficient evidence for a specific red blood cell transfusion threshold for children on ECMO, 53 instead recommending transfusion decision-making to take into account evidence of inadequate systemic or regional oxygen delivery, adoption of blood conservation procedures and minimization of donor exposure. 54 Many center protocols maintain hemoglobin between 10-12 g/dl.…”

Section: Blood Product Administrationmentioning

confidence: 99%

Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure

et al. 2021

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These guidelines are applicable to neonates and children with cardiac failure as indication for extracorporeal life support. These guidelines address patient selection, management during extracorporeal membrane oxygenation, and pathways for weaning support or bridging to other therapies. Equally important issues, such as personnel, training, credentialing, resources, follow-up, reporting, and quality assurance, are addressed in other Extracorporeal Life Support Organization documents or are center-specific.

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Section: Blood Product Administrationmentioning

confidence: 99%

Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure

et al. 2021

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“…11,31,32 The propensity for neonates on ECMO to suffer from hemolysis may be due to smaller caliber cannulas causing increased shear stress, neonatal red blood cell fragility, and higher transfusion burden. 33,34 It is unclear if the higher rates of hemolysis seen with centrifugal pumps are responsible for other clinical outcomes. In agreement with our findings, other studies have also found an association between higher hemolysis rates and increased in-hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Centrifugal and Roller Pumps in Neonatal and Pediatric Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis of Clinical Outcomes

et al. 2021

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“…If an RBC transfusion started <4 h from the end of a prior transfusion, the two were combined into a single transfusion event. We grouped transfusion events by pre‐transfusion hemoglobin concentration (<10 g/dL, 10‐ < 12 g/dL, and ≥ 12 g/dL), using cutoffs that have been described in prior studies of transfusion in pediatric ECMO populations 9,14–16 . Pre‐transfusion hemoglobin was defined as the most recent level pre‐transfusion, not <1 h and not more than 12 h before the transfusion start time.…”

Section: Methodsmentioning

confidence: 99%

Impact of red blood cell transfusion on regional cerebral oxygen saturation during pediatric ECMO

et al. 2023

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Background Low cerebral regional tissue oxygenation (crSO2) is associated with unfavorable neurological outcomes in children requiring extracorporeal membrane oxygenation (ECMO) support. Red blood cell (RBC) transfusion can improve brain oxygenation and crSO2 has been proposed as a noninvasive monitoring tool that could aid in RBC transfusion decision‐making. However, how crSO2 responds to RBC transfusion is largely unknown. Study Design and Methods This was a retrospective, observational cohort study of all patients <21 years supported on ECMO at a single institution from 2011 to 2018. Transfusion events were grouped by pre‐transfusion hemoglobin concentration (<10, 10‐ < 12, and ≥ 12 g/dL). Post‐ versus pre‐transfusion crSO2 changes were analyzed using linear mixed‐effects models. Results The final cohort included 830 transfusion events in 111 patients. Hemoglobin increased significantly post‐ versus pre‐RBC transfusion (estimated mean increase of 0.47 g/dL [95% CI, 0.35–0.58], p < .001), as did crSO2 (estimated mean increase of 1.82 percentage points [95% CI, 1.23–2.40], p < .001). Larger improvements in crSO2 were associated with lower pre‐transfusion crSO2 values (p < .001). There was no difference in mean change in crSO2 across the three hemoglobin groups in unadjusted analysis (p = .5) or after adjusting for age, diagnostic category, and pre‐transfusion rSO2 (p = .15). Pre‐transfusion crSO2 was <50% for 112 of 830 (13.5%) transfusion events, with only 30 (26.8%) crSO2 measurements noted to increase ≥50% post‐transfusion. Discussion Among neonatal and pediatric patients on ECMO support, there was a statistically significant increase in crSO2 following RBC transfusion, although clinical significance needs to be investigated further. The effect was strongest among patients with lower crSO2 pre‐transfusion.

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RBC Exposure in Pediatric Extracorporeal Membrane Oxygenation: Epidemiology and Factors Associated With Large Blood Transfusion Volume*

Abstract: Bleeding during extracorporeal membrane oxygenation, frequent laboratory draws, and younger age were associated with increased RBC exposure during extracorporeal membrane oxygenation. Higher transfusion volume was associated with increased mortality.

Cited by 20 publications

References 15 publications

Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure

Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure

Centrifugal and Roller Pumps in Neonatal and Pediatric Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis of Clinical Outcomes

Impact of red blood cell transfusion on regional cerebral oxygen saturation during pediatric ECMO

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