• Senta Jorinde Raasveld, Mina Karami, Walter M van den Bergh, Annemieke Oude Lansink-Hartgring, Franciska van der Velde, Jacinta J Maas, Pablo van de Berg, Maarten de Haan, Roberto Lorusso, DelnoijThijs S RTSRDepartment of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands., Dinis Dos Reis Miranda, Loes Mandigers, Erik Scholten, Martijn Overmars, Silvio TacconeFabioFDepartment of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium., Alexandre Brasseur, Dieter F Dauwe, Erwin De Troy, Greet Hermans, Philippe Meersseman, Federico Pappalardo, Evgeny Fominskiy, Višnja Ivancan, Robert Bojčić, Jesse de Metz, Bas van den Bogaard, Dirk W Donker, Christiaan L Meuwese, Martin de Bakker, Benjamin Reddi, Sanne de Bruin, Wim K Lagrand, HenriquesJosé P SJPSDepartment of Cardiology, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, The Netherlands., Lars M Broman, and VlaarAlexander P JAPJDepartment of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, The Netherlands..
• Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, The Netherlands.
• Crit. Care Med. 2022 Feb 1; 50 (2): 224234224-234.

ObjectivesIn 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.DesignMixed method approach combining multicenter retrospective study and survey.SettingSixteen ICUs worldwide.PatientsPatients receiving venovenous extracorporeal membrane oxygenation between January 2018 and July 2019.InterventionsNone.Measurements And Main ResultsThe primary outcome was the proportion receiving RBC, the amount of RBC units given daily and in total. Furthermore, the course of hemoglobin over time during extracorporeal membrane oxygenation was assessed. Demographics, extracorporeal membrane oxygenation characteristics, and patient outcome were collected. Two-hundred eight patients received venovenous extracorporeal membrane oxygenation, 63% male, with an age of 55 years (45-62 yr), mainly for acute respiratory distress syndrome. Extracorporeal membrane oxygenation duration was 9 days (5-14 d). Prior to extracorporeal membrane oxygenation, hemoglobin was 10.8 g/dL (8.9-13.0 g/dL), decreasing to 8.7 g/dL (7.7-9.8 g/dL) during extracorporeal membrane oxygenation. Nadir hemoglobin was lower on days when a transfusion was administered (8.1 g/dL [7.4-9.3 g/dL]). A vast majority of 88% patients received greater than or equal to 1 RBC transfusion, consisting of 1.6 U (1.3-2.3 U) on transfusion days. This high transfusion occurrence rate was also found in nonbleeding patients (81%). Patients with a liberal transfusion threshold (hemoglobin > 9 g/dL) received more RBC in total per transfusion day and extracorporeal membrane oxygenation day. No differences in survival, hemorrhagic and thrombotic complication rates were found between different transfusion thresholds. Also, 28-day mortality was equal in transfused and nontransfused patients.ConclusionsTransfusion of RBC has a high occurrence rate in patients on venovenous extracorporeal membrane oxygenation, even in nonbleeding patients. There is a need for future studies to find optimal transfusion thresholds and triggers in patients on extracorporeal membrane oxygenation.Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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