Thresholds for Transfusion Practice During ECMO Support. A Systematic Review and Network Meta-Analysis.

Area of Science:

• Critical Care Medicine
• Transfusion Medicine
• Cardiovascular Surgery

Background:

• Extracorporeal membrane oxygenation (ECMO) necessitates careful management of blood product transfusions.
• The optimal hemoglobin threshold for red blood cell (RBC) transfusions during ECMO remains debated.
• Restrictive transfusion strategies aim to minimize RBC exposure and associated risks.

Purpose of the Study:

• To compare the efficacy of restrictive versus liberal transfusion strategies in adult ECMO patients.
• To evaluate the impact on the number of RBC transfusions and secondary outcomes.
• To determine optimal hemoglobin thresholds for transfusion during ECMO.

Main Methods:

• A systematic literature search was performed across major databases (Medline, Embase, Scopus).
• Network meta-analysis included five retrospective observational studies involving 1339 adult ECMO patients.
• Outcomes assessed included RBC, fresh frozen plasma (FFP), and platelet transfusions, ECMO duration, and survival.

Main Results:

• A restrictive transfusion threshold of 7 g/dL significantly reduced RBC transfusions compared to liberal strategies (MD -5.75).
• FFP and platelet transfusions were reduced at thresholds of 7 g/dL and 9 g/dL.
• A threshold of 7 g/dL improved 28-day survival, while a 9 g/dL threshold was associated with shorter ECMO duration.

Conclusions:

• Restrictive transfusion strategies, particularly at a 7 g/dL hemoglobin threshold, effectively reduce blood product administration in ECMO patients.
• This approach is associated with improved 28-day survival and potentially shorter ECMO duration.
• Findings may not apply to patients with severe thrombocytopenia, bleeding disorders, or cardiac conditions requiring higher transfusion thresholds.