RBC Transfusion Practice in Pediatric Extracorporeal Membrane Oxygenation Support
Year: 2018
Type: article
Abstract: OBJECTIVES: To determine RBC transfusion practice and relationships between RBC transfusion volume and mortality in infants and children treated with extracorporeal membrane oxygenation. DESIGN: Secondary analysis of a multicenter prospective observational study. SETTING: Eight pediatric institutions within the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Collaborative Pediatric Critical Care Research Network. PATIENTS: Patients age less than 19 years old treated with extracorporeal membrane oxygenation at a participating center. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical data and target hemoglobin or hematocrit values (if set) were recorded daily by trained bedside extracorporeal membrane oxygenation specialists and research coordinators. Laboratory values, including hemoglobin and hematocrit, were recorded daily using the value obtained closest to 8:00 AM. RBC transfusion was recorded as total daily volume in mL/kg. Multivariable logistic regression was used to determine the relationship between RBC transfusion volume and hospital mortality, accounting for potential confounders. Average goal hematocrits varied across the cohort with a range of 27.5-41.3%. Overall, actual average daily hematocrit was 36.8%, and average RBC transfusion volume was 29.4 mL/kg/d (17.4-49.7 mL/kg/d) on extracorporeal membrane oxygenation. On multivariable analysis, each additional 10 mL/kg/d of RBC transfusion volume was independently associated with a 9% increase in odds of hospital mortality (adjusted odds ratio, 1.09 [1.02-1.16]; p = 0.009). CONCLUSIONS: In this multicenter cohort of pediatric extracorporeal membrane oxygenation patients, daily hematocrit levels were maintained at normal or near-normal values and RBC transfusion burden was high. RBC transfusion volume was independently associated with odds of mortality. Future clinical studies to identify optimum RBC transfusion thresholds for pediatric extracorporeal membrane oxygenation are urgently needed.
Source: Critical Care Medicine
Institutions: Nationwide Children's Hospital, Abigail Wexner Research Institute, University of Utah, Children's Hospital of Philadelphia, University of Michigan, Children's Hospital Los Angeles, Children's National, Children's Hospital of Pittsburgh, University of California, Los Angeles, Mattel Children's Hospital, Wayne State University, Children's Hospital of Michigan, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Inova Fairfax Hospital
Language: English
Subfield: Biochemistry (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Neurodevelopmental Outcome after Cardiac Intensive Care, G1223667318, G1328420516, Collaborative Pediatric Critical Care Research Network, Data Coordinating Center for the Collaborative Pediatric Critical Care Research Network, Pediatric Critical Care Research Network at Children's Hospital of Philadelphia, Controlled Trial of Two Lung Protective Ventilation Modes in Acute Lung Injury, Collaborative Pediatric Critical Care Research Network (CPCCRN) at Children's National, Renewal Application for the Childrens Hospital of Pittsburgh Collaborative Pediatric Critical Care Research Network Site, Role of microRNA in stored RBC induced innate immune suppression, Predicting Morbidity from Pediatric Critical Care, Collaborative Pediatric Critical Care Research Network, Collaborative Pediatric Research Critical Care Network(U10), Pediatric Critical Care Research Network at Children's Hospital of Philadelphia, Los Angeles Center of the Collaborative Pediatric Critical Care Research Network, Collaborative Pediatric Critical Care Research Network - Clinical Site, Collaborative Pediatric Critical Care Research Network At Children's Hospital of
OpenAlex ID: W2792875522