Blood Transfusion Strategies in Patients Undergoing Extracorporeal Membrane Oxygenation

Hyoung Soo Kim, Sunghoon Park, Hyoung Soo Kim, Sunghoon Park

Abstract

Extracorporeal membrane oxygenation (ECMO) is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs)/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.

Keywords: blood transfusion; extracorporeal membrane oxygenation.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Copyright © 2017 The Korean Society of Critical Care Medicine.

Figures

Figure 1.
Figure 1.
Relationship between oxygen uptake (VO2) and oxygen delivery (DO2). Oxygen uptake remains stable until oxygen delivery falls below the critical point.

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