Impact of red blood cell transfusion on regional cerebral oxygen saturation during pediatric ECMO.
Impact of red blood cell transfusion on regional cerebral oxygen saturation during pediatric ECMO.
复制标题
儿科 ECMO 期间红细胞输注对局部脑氧饱和度的影响。
DOI：
10.1111/trf.17317
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发表时间：
2023
期刊：
影响因子：
2.9
通讯作者：
Bembea,MelaniaM
中科院分区：
文献类型：
--
作者：
Garcia,AlejandroV;Velez,AnaKaren;Surma,Victoria;Jager,LeahR;Bembea,MelaniaM
背景：在需要体外膜肺氧合（ECMO）支持的儿童中，低脑局部组织氧合（crSO 2）与不利的神经系统结局相关。红细胞（RBC）输注可以改善脑氧合，crSO 2已被提议作为一种非侵入性监测工具，可以帮助做出RBC输注决策。研究设计和方法这是一项回顾性、观察性队列研究，研究对象为2011年至2018年在一家机构接受ECMO支持的所有<21岁患者。根据输血前血红蛋白浓度（<10、10-< 12和≥ 12 g/dL）对输血事件进行分组。使用线性混合效应模型分析输血后与输血前crSO 2变化。ResultsThe最终队列包括111例患者的830例输血事件。与RBC输注前相比，血红蛋白在输注后显著增加（估计平均增加0.47 g/dL [95% CI，0.35-0.58]，p<0.001），crSO 2也是如此（估计平均增加1.82个百分点[95% CI，1.23-2.40]，p<0.001）。crSO 2的较大改善与较低的输血前crSO 2值相关（p< .001）。在未校正分析中（p= .5）或校正年龄、诊断类别和输血前rSO 2后（p= .15），三个血红蛋白组的crSO 2平均变化无差异。830例输血事件中有112例（13.5%）输血前crSO 2 <50%，仅30例（26.8%）输血后crSO 2测量值增加≥ 50%.Discussion在ECMO支持的新生儿和儿科患者中，RBC输注后crSO 2有统计学显著性增加，但临床意义需要进一步研究。在输血前crSO 2较低的患者中效果最强。
BackgroundLow cerebral regional tissue oxygenation (crSO2) is associated with unfavorable neurological outcomes in children requiring extracorporeal membrane oxygenation (ECMO) support. Red blood cell (RBC) transfusion can improve brain oxygenation and crSO2 has been proposed as a noninvasive monitoring tool that could aid in RBC transfusion decision‐making. However, how crSO2 responds to RBC transfusion is largely unknown.Study Design and MethodsThis was a retrospective, observational cohort study of all patients <21 years supported on ECMO at a single institution from 2011 to 2018. Transfusion events were grouped by pre‐transfusion hemoglobin concentration (<10, 10‐ < 12, and ≥ 12 g/dL). Post‐ versus pre‐transfusion crSO2 changes were analyzed using linear mixed‐effects models.ResultsThe final cohort included 830 transfusion events in 111 patients. Hemoglobin increased significantly post‐ versus pre‐RBC transfusion (estimated mean increase of 0.47 g/dL [95% CI, 0.35–0.58],p< .001), as did crSO2 (estimated mean increase of 1.82 percentage points [95% CI, 1.23–2.40],p< .001). Larger improvements in crSO2 were associated with lower pre‐transfusion crSO2 values (p< .001). There was no difference in mean change in crSO2 across the three hemoglobin groups in unadjusted analysis (p= .5) or after adjusting for age, diagnostic category, and pre‐transfusion rSO2 (p= .15). Pre‐transfusion crSO2 was <50% for 112 of 830 (13.5%) transfusion events, with only 30 (26.8%) crSO2 measurements noted to increase ≥50% post‐transfusion.DiscussionAmong neonatal and pediatric patients on ECMO support, there was a statistically significant increase in crSO2 following RBC transfusion, although clinical significance needs to be investigated further. The effect was strongest among patients with lower crSO2 pre‐transfusion.