title: Bleeding, Transfusion, and Mortality on Extracorporeal Life Support: ECLS Working Group on Thrombosis and Hemostasis.
abstract: BACKGROUND
  Bleeding may occur frequently during adult extracorporeal life support; however, there are no detailed investigations of bleeding events, red blood cell transfusion, and their impact on mortality. The purpose of our study was to characterize the incidence of bleeding and red blood cell transfusion during adult extracorporeal life support and examine the impact on mortality.
  
  
  METHODS
  We performed a retrospective analysis of adult extracorporeal life support patients over approximately a 3-year period. The incidence of bleeding events and transfusions were recorded. Unadjusted and adjusted multivariate logistic regression analyses were performed to estimate the odds of inhospital mortality among patients with bleeding and for each red blood cell unit transfused. Ninety-day survival was compared between patients who bled and those who did not.
  
  
  RESULTS
  Serious bleeding events occurred in 74 of 132 patients (56.1%), and the rate of bleeding was 10 events per 100 days. The crude odds ratio for inhospital mortality in patients who bled was 2.22 (95% confidence interval [CI]: 1.00 to 4.94, p = 0.05); and for each unit of red blood cells transfused, it was 1.03 (95% CI: 1.01 to 1.04, p = 0.005). The adjusted odds ratios for bleeding and red blood cell transfusions were 0.90 (95% CI: 0.37 to 2.19, p = 0.82) and 1.03 (95% CI: 1.00 to 1.06, p = 0.04). There was a trend toward decreased 90-day survival among patients who bled compared with patients who did not (46.7% versus 64.9%, p = 0.08).
  
  
  CONCLUSIONS
  Bleeding and red blood cell transfusion occur frequently during adult extracorporeal life support, but only the amount of red blood cell transfusion is associated with inhospital mortality after controlling for confounding variables.
authors.affiliation: Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: mmazzeffi@anes.umm.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Mazzeffi
authors.affiliation: Department of Shock Trauma Critical Care, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: John
authors.initials: J
authors.lastname: Greenwood
authors.affiliation: Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Shock Trauma Critical Care, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Jay
authors.initials: J
authors.lastname: Menaker
authors.affiliation: Department of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Raymond
authors.initials: R
authors.lastname: Rector
authors.affiliation: Department of Shock Trauma Critical Care, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Herr
authors.affiliation: Department of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kon
authors.affiliation: Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Joy
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Bartley
authors.initials: B
authors.lastname: Griffith
authors.affiliation: Department of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Keshava
authors.initials: K
authors.lastname: Rajagopal
authors.affiliation: Department of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Si
authors.initials: S
authors.lastname: Pham
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D006489:Hemostatic Techniques; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology