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The following is a summary of “Effects of blood cell salvage on transfusion requirements after decannulation from veno-venous extracorporeal membrane oxygenation: an emulated trial analysis,” published in the December 2024 issue of Critical Care by Camarda et al. 

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a supportive therapy for acute respiratory failure, associated with a higher risk of packed red blood cell (PRBC) transfusion, while the efficacy of blood cell salvage (BCS) in reducing transfusions remained unclear. 

Researchers conducted a retrospective study to estimate the effect of BCS during ECMO decannulation on the amount of PRBC transfused. 

They compared BCS with non-blood cell salvage (n-BCS) in patients from 2 ECMO centers in the United Kingdom. Inverse propensity of treatment weighting was applied to adjust for confounding variables, and the average treatment effect of BCS on PRBC transfused within 2 days of ECMO decannulation and on changes in hemoglobin (Hb) levels was estimated. 

The results showed 841 patients who underwent VV-ECMO decannulation were included in the analysis. The estimated marginal mean number of PRBCs transfused with BCS was 0.2 (95%CI: 0.16, 0.25) units, compared to 0.51 (95%CI: 0.44, 0.59) units with n-BCS, indicating an average treatment effect of −0.31 (95%CI: −0.40, −0.22) units, BCS reduced the likelihood of receiving any PRBC transfusion by 17.1% (95%CI: 11.1%, 22.9%), with a number needed to treat of 6 (95%CI: 5, 9) for preventing 1 PRBC transfusion. The expected difference in Hb levels after decannulation between BCS and n-BCS was 5.0 (95%CI: 4.2, 5.8) g/L. 

Investigators concluded the use of blood component separation during VV-ECMO decannulation was an effective strategy to increase HB levels and decrease PRBC transfusions. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05177-7