Veno-arterial extracorporeal membrane oxygenation without allogeneic blood transfusion: An observational cohort study

Authors

Alison Grazioli, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Michael Plazak, Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA.
Siamak Dahi, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Joseph Rabin, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Ashley Menne, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Mehrdad Ghoreishi, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Bradley Taylor, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Seth Perelman, Department of Anesthesiology, New York University School of Medicine, New York, NY, USA.
Michael Mazzeffi, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine, Washington, DC, USA.

Document Type

Journal Article

Publication Date

10-1-2023

Journal

Perfusion

Volume

38

Issue

7

DOI

10.1177/02676591221119015

Keywords

ECMO; blood transfusion; cardiac surgery; cardiogenic shock; intensive care

Abstract

INTRODUCTION: It remains unclear whether patients who will not accept allogeneic blood transfusion can be managed successfully with veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO). The objective of our study was to determine what percentage of V-A ECMO patients were managed without allogeneic blood transfusion. METHODS: This was a retrospective, observational cohort study of patients with cardiogenic shock requiring V-A ECMO between January 2016 and January 2019. The primary outcome was avoidance of any allogeneic blood transfusion. RESULTS: Of the 206 patients included, 23 (11.2%) were managed without any allogeneic blood transfusion. Fourteen (60.9%) avoided allogeneic blood transfusion during their entire hospitalization. "No-transfusion" patients were younger, more commonly men, were less likely to have a prior diagnosis of hypertension or coronary artery disease, had higher baseline hemoglobin, had higher SAVE scores, and were less likely to have received aspirin before ECMO. No patients in the "no-transfusion" group had major bleeding compared to 35% of patients in the blood transfusion group ( < 0.001). In-hospital mortality was 17.4% for those who avoided blood transfusion and 41.5% for those who received blood transfusion ( = 0.04). ECMO duration was significantly shorter in patients who avoided blood transfusion compared to those who received blood transfusion (median 3.5 vs 7 days, < 0.001). CONCLUSIONS: Select patients can be successfully managed on V-A ECMO without allogeneic blood transfusion. Jehovah's Witnesses and other patients with objections to allogeneic transfusion might be offered V-A ECMO if its anticipated duration is short (e.g. <7 days) and baseline hemoglobin concentration is high (e.g. ≥10 mg/dL).

APA Citation

Grazioli, Alison; Plazak, Michael; Dahi, Siamak; Rabin, Joseph; Menne, Ashley; Ghoreishi, Mehrdad; Taylor, Bradley; Perelman, Seth; and Mazzeffi, Michael, "Veno-arterial extracorporeal membrane oxygenation without allogeneic blood transfusion: An observational cohort study" (2023). GW Authored Works. Paper 3709.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3709

Department

Anesthesiology and Critical Care Medicine