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

Doyle, Andrew J and Richardson, Carla and Sanderson, Barnaby and Wong, Katie and Wyncoll, Duncan and Camporota, Luigi and Barrett, Nicholas A and Hunt, Beverley J and Retter, Andrew (2020) Restrictive Transfusion Practice in Adults Receiving Venovenous Extracorporeal Membrane Oxygenation: A Single-Center Experience. Critical care explorations, 2 (1). e0077. ISSN 2639-8028.

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Official URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC70639...

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.

Item Type: Article
Subjects: WH Haemic and lymphatic systems. Haematology
Divisions: Planned IP Care > Oncology and Clinical Haematology
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 20 Mar 2020 15:08
Last Modified: 20 Mar 2020 15:08
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2936

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