RBC Transfusion Practice in Pediatric Extracorporeal Membrane Oxygenation Support

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. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/29S62lw). Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063106, U10HD063114 and U01HD049934. JAM is supported by K08HL123925. Drs. Muszynski, Reeder, Berg, Shanley, Newth, Pollack, Wessel, Carcillo, Harrison, Meert, Dean, Jenkins, Tamburro, and Dalton received support for article research from the National Institutes of Health (NIH). Drs. Reeder's, Shanley's, Pollack's, Wessel's, Harrison's, and Meert's institutions received funding from the NIH. Drs. Berg's, Carcillo's, and Dean's institutions received funding from the National Institute of Child Health and Human Development. Dr. Shanley received funding from International Pediatric Research Foundation, Raynes McCarty Law Firm, Tanoury, Nauts, and McKinney and Garbarino, PLLC. Dr. Newth received funding from Philips Research North America. Drs. Jenkins and Tamburro disclosed government work. Dr. Tamburro's institution received funding from U.S. Food and Drug Administration (FDA) Office of Orphan Products Development and ONY (provided surfactant free of charge for the previously mentioned U.S. FDA trial). Dr. Dalton received funding from Innovative extracorporeal membrane oxygenation (ECMO) Concepts (consultant), Maquet (speaker bureau and consultant), and rEVO Biologics, and she disclosed off-label product use of ECMO-related equipment. Dr. Hall disclosed that he does not have any potential conflicts of interest. For information regarding this article, E-mail: jennifer.muszynski@nationwidechildrens.org Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

http://ift.tt/2FlfMit