Developing a veno-venous extracorporeal membrane oxygenation program during the COVID-19 pandemic: Don’t forget to notify the blood bank - 21/11/24

Doi : 10.1016/j.tracli.2024.10.008

Alexis Berger ^a, Christophe Lelubre ^b, Charles Chevalier ^c, Jacqueline Massart ^a, David Fagnoul ^a, Steeve Dangotte ^d, Sotirios Marinakis ^d, Karim Homsy ^d, Badih Elnakadi ^d, Patrick Biston ^a, Michael Piagnerelli ^a,^e,^⁎
^a Intensive Care, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
^b Internal Medicine, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
^c Hematology Unit, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
^d Department of Cardiothoracic Surgery, CHU-Charleroi Chimay, Marie-Curie Hospital, Université Libre de Bruxelles, 6042 Charleroi, Belgium
^e Experimental Medicine Laboratory, CHU-Charleroi Chimay, A Vésale Hospital. ULB 222 Unit, Université Libre de Bruxelles, 6110 Montigny-le-Tilleul, Belgium

^⁎Corresponding author at: Intensive Care, CHU-Charleroi Chimay, Université Libre de Bruxelles, 140, chaussée de Bruxelles, 6042 Charleroi Belgium.Intensive CareCHU-Charleroi ChimayUniversité Libre de Bruxelles140, chaussée de BruxellesCharleroi6042Belgium

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Highlights

•	Respiratory failure was treated by vvECMO during the pandemic linked to COVID- 19. This technique required many resources such as RBC transfusions.
•	We report that in an vvECMO program almost 80% of patients are transfused with a median value of 0.5 units/day on vvECMO.
•	These data are important when blood availability is decreased due to a pandemic and illustrates the need for studies on optimizing blood management including therapeutic anticoagulation target, threshold or alternatives for RBC transfusion.

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Abstract

Objectives

During the SARS-CoV-2 pandemic, there has been significant increased use of vvECMO as rescue therapy. Patients with COVID-19 as anticoagulation is needed for vvECMO support, may develop bleeding complications requiring an increased number of RBC transfusions. We would like to report the RBC transfusion needs following the implementation of an ECMO program. Data on blood usage in this population is important in view of the decline in donations due to the pandemic.

Study Design and Methods

We analyzed data on RBC transfusions in patients who required vvECMO for COVID-19 related ARDS in a Belgian ICU from March 2020 to March 2022. The primary end point was RBC transfusion requirements. and the relationship to outcome. We also analyzed the evolution of this requirement during the four waves.

Results

We admitted 538 patients for hypoxemic ARDS due to COVID-19. Sixty patients (11%) required vvECMO, of whom 27 (45%) died. Forty-seven (78%) of the vvECMO patients were transfused a total of 403 packed RBC units. Sites of hemorrhagic complications were ECMO cannulation sites and lungs. RBC transfusion per patient per day on vvECMO was 0.50 [0.30–0.67] units. There were no differences in hemorrhagic complications in vvECMO survivors and non-survivors.

The percentage of vvECMO patients receiving a RBC transfusion increased slightly during the last COVID-19 wave, with 92 % of patients transfused.

Conclusions

vvECMO program is associated with a major need for RBC transfusions. These data are important when blood availability is decreased due to a pandemic and illustrates the need for studies on optimizing blood management including therapeutic anticoagulation target, threshold for RBC transfusion or alternatives to RBC transfusion.

Le texte complet de cet article est disponible en PDF.

Keywords : ARDS, COVID-19, ECMO, Red blood cell, Bleeding, Transfusion