PRospective multicenter Observational study on Transfusion practice in vv-ECMO patients: The PROTECMO Study. Preliminary data on hemoglobin values in Intensive Care Medicine Experimental
2021
ASL Cuneo 1
AOU Città della Salute di Torino
Tipo pubblicazione
Conference Abstract
Autori/Collaboratori (20)Vedi tutti...
Fanelli V
Hssain AA
Duburcq T
et alii...
Abstract
Introduction. The optimal hemoglobin (Hb) during V-V ECMO is still debated. A previous survey showed that high volume centers (> 20 run/year) tolerate lower Hb values. Objectives. To describe the level of Hb and the trigger for transfusion adopted worldwide in a large cohort of V-V ECMO in a defined timeframe and explore its relations with clinical outcomes. Methods. Prospective multicenter observational international cohort study on consecutive V-V ECMO patients (during one year or up to 20 patients, having complete data) enrolled by 40 centers in 19 countries from Jan 2019 to Dec 2020. Patient were described for preECMO characteristics and followed daily for 28 days or less if the time on ECMO was shorter. Generalized Estimating Equations (GEE) models were applied in order to consider within subject repeated measurements over time. Hb was registered daily and before the first daily transfusion episode. Centers were considered at low (< 12), medium (12-20), high (> 20) volume, according to the number of cases per year. Results. 635 patients were enrolled with the following baseline pre-ECMO characteristics [median, 95% CI or N(%)]: age 52 years (40-60), male gender 444 (70%), BMI 28.5 kg/m2 (24.9-34), hospital stay 5.4 days (1.7-11), ICU stay 3 days (0.9-7), mechanical ventilation 2.1 days (0.6-5.5), PaO2/FiO2 ratio 70 (59-94), SAPS-2 40 (30-55), SOFAscore 10 (7-12), PRESERVE score 4 (2-5), RESPscore 2 (0-4), Hb 10.8 (9.4-12.30), and hematocrit 33.5% (29.5-38). Main causes of ARF were COVID-19 (N 204, 32.2%), other viral pneumonia (N 119, 18.8%) and bacterial pneumonia (N 102, 16.1%). Main ECMO configurations were fem-jug (64.7%) and fem-fem 25.2%. At baseline Hb was not significantly higher in patients discharged alive from the ICU compared to non-survivors: Hb 11.1 ± 2.4 g/dl vs 10.8 ± 2.3 g/dl, p = 0.15. A lower baseline value was tolerated at higher volume center: 11.3 (low and medium volume) vs 10.7 high volume; p = 0.02. (Fig. 1a) But in a Kaplan-Mei
DOI : 10.1186/s40635-021-00413-8
Keywords
virus pneumonia; veno-venous ECMO; prospective study; outcome assessment; survivor; survival analysis; protein expression; preliminary data; observational study; multicenter study; male; major clinical study; human; hospitalization; Horowitz index; hematocrit; gene expression; conference abstract; coronavirus disease 2019; female; gender; cohort analysis; body weight; clinical outcome; body mass; bacterial pneumonia; artificial ventilation; adult; hemoglobin; endogenous compound; adenosine diphosphate ribosylation factor;