title: RBC transfusion in pediatric patients supported with extracorporeal membrane oxygenation: is there an impact on tissue oxygenation?
abstract: OBJECTIVE
  To examine first the RBC transfusion practice in pediatric patients supported with extracorporeal membrane oxygenation and second the relationship between transfusion of RBCs and changes in mixed venous saturation (SvO2) and cerebral regional tissue oxygenation, as measured by near-infrared spectroscopy in patients supported with extracorporeal membrane oxygenation.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Pediatric, cardiovascular, and neonatal ICUs of a tertiary care children's hospital.
  
  
  METHODS
  All pediatric patients supported with extracorporeal membrane oxygenation between January 1, 2010, and December 31, 2010.
  
  
  METHODS
  None.
  
  
  RESULTS
  There were 45 patients supported with extracorporeal membrane oxygenation. The median (interquartile range) phlebotomy during extracorporeal membrane oxygenation was 75 mL/kg (33, 149 mL/kg). A total of 617 transfusions were administered (median, 9 per patient; range = 1-57). RBC volumes transfused during extracorporeal membrane oxygenation support were 254 mL/kg (136, 557) and 267 mL/kg (187, 393; p = 0.82) for cardiac and noncardiac patients, respectively. Subtracting the volume of RBCs used for extracorporeal membrane oxygenation circuit priming, median RBC transfusion volumes were 131 and 80 mL/kg for cardiac and noncardiac patients, respectively (p = 0.26). The cardiac surgical patients received the most RBCs (529 vs 74 mL/kg for nonsurgical cardiac patients). The median hematocrit maintained during extracorporeal membrane oxygenation support was 37%, with no difference between cardiac and noncardiac patients. Patients supported with extracorporeal membrane oxygenation were exposed to a median of 10.9 (range, 3-43) individual donor RBC units. Most transfusions resulted in no significant change in either SvO2 or cerebral near-infrared spectroscopy. Only 5% of transfusions administered (31/617) resulted in an increase in SvO2 of more than 5%, whereas an increase in cerebral near-infrared spectroscopy of more than 5 was only observed in 9% of transfusions (53/617). Most transfusions (73%) were administered at a time when the pretransfusion SvO2 was more than 70%.
  
  
  CONCLUSIONS
  Patients supported with extracorporeal membrane oxygenation were exposed to large RBC transfusion volumes for treatment of mild anemia resulting from blood loss, particularly phlebotomy. In the majority of events, RBC transfusion did not significantly alter global tissue oxygenation, as assessed by changes in SvO2 and cerebral near-infrared spectroscopy. Most transfusions were administered at a time at which the patient did not appear to be oxygen delivery dependent according to global measures of tissue oxygenation.
authors.affiliation: 1Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR. 2ECMO Team, Arkansas Children's Hospital, Little Rock, AR. 3Department of Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Fiser
authors.forename: Katherine
authors.initials: K
authors.lastname: Irby
authors.forename: Rebekah M
authors.initials: RM
authors.lastname: Ward
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.forename: Wes
authors.initials: W
authors.lastname: McKamie
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Howard L
authors.initials: HL
authors.lastname: Corwin
mesh_terms: D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000706:statistics & numerical data*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006400:Hematocrit; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010100:Oxygen / Q000097:blood*; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared
chemical_list: D010100:Oxygen