title: Blood conservation in extracorporeal membrane oxygenation for acute respiratory distress syndrome.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation support (ECMO) typically requires multiple blood transfusions and is associated with frequent bleeding complications. Blood transfusions are known to increase morbidity and mortality in critically ill patients, which may extend to patients receiving ECMO. Aiming to reduce transfusion requirements, we implemented a blood conservation protocol in adults with severe acute respiratory distress syndrome (ARDS) receiving ECMO.
  
  
  METHODS
  This was a retrospective study of adults receiving ECMO for ARDS after initiation of a blood conservation protocol that included a transfusion trigger of hemoglobin of less than 7.0 g/dL, use of low-dose anticoagulation targeting an activated partial thromboplastin time of 40 to 60 seconds, and autotransfusion of circuit blood during decannulation. The primary objective was to evaluate transfusion requirements during ECMO support. Clinical outcomes included survival, neurologic function, renal function, bleeding, and thrombotic complications.
  
  
  RESULTS
  The analysis included 38 patients; of these, 24 (63.2%) received a transfusion while receiving ECMO. Median hemoglobin was 8.29 g/dL. A median of 1.0 units (range, 250 to 300 mL) was transfused during ECMO support over a median duration of 9.0 days, equivalent to 0.11 U/d (range, 27.5 to 33.3 mL/d). The median activated partial thromboplastin time was 46.5 seconds. Bleeding occurred in 10 patients (26.3%); severe bleeding occurred in 2 patients (5.3%). Twenty-eight patients (73.7%) survived to hospital discharge.
  
  
  CONCLUSIONS
  Implementation of a blood conservation protocol in adults receiving ECMO for ARDS resulted in lower transfusion requirements and bleeding complications than previously reported in the literature and was associated with comparable survival and organ recovery.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Cara L
authors.initials: CL
authors.lastname: Agerstrand
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Burkart
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Darryl C
authors.initials: DC
authors.lastname: Abrams
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Bacchetta
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York. Electronic address: hdb5@columbia.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D057668:Bloodless Medical and Surgical Procedures; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006454:Hemoglobins