Thao, Le Thi Phuong and Buscher, Hergen and Nguyen, Tri-Long and Martucci, Gennaro and Gratz, Johannes and Trummer, Georg and Schmidt, Matthieu and Gautier, Melchior and Serra, Alexis and Takeda, Koji and Pooth, Jan-Steffen and Rahn, Kevin and Geismann, Florian and Lubnow, Matthias and Retter, Andrew and Nair, Priya and Vlok, Ruan and Siriwardena, Maithri and Winearls, James and Walsham, James and Gattas, David and Aneman, Anders and Fulcher, Bentley and Newman, Sally and Reynolds, Claire and Arcadipane, Anthonio and Shekar, Kiran and Hodgson, Carol and Pellegrino, Vincent and Mueller, Thomas and Brodie, Daniel and McQuilten, Zoe and Int ECMO Network ECMONet, (2025) Liberal or restrictive transfusion for veno-arterial extracorporeal membrane oxygenation patients: a target trial emulation using the OBLEX study data. CRITICAL CARE, 29 (1): 360. ISSN 1364-8535, 1466-609X
Full text not available from this repository. (Request a copy)Abstract
BackgroundThe optimal transfusion threshold for patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains uncertain.MethodsWe used data from OBLEX (ClinicalTrials.gov: NCT03714048), an international, prospective, observational study conducted across 12 centres in Australia, Europe, and North America between 2019 and 2022. The study collected information on patient demographics, bleeding risk factors, transfusion practices during the first seven days of ECMO, and in-hospital mortality. Using these data, we emulated a target trial comparing the effects of liberal transfusion practice (transfusion initiated at Hb >= 90 g/L) and restrictive transfusion practice (transfusion initiated at Hb <= 70 g/L) on hospital mortality within seven days of ECMO initiation. Sequential trials approach was used to estimate the causal contrast.ResultsA total of 534 patients were included, with 46% dying during hospitalisation. After accounting for potential confounders, the liberal transfusion practice demonstrated a modest survival benefit within the first two days of ECMO, with differences in survival probabilities of 12% (95% CI 3% to 21%) at day 2 and 13% (95% CI 2% to 25%) at day 3, corresponding to the number needed to treat (NNT) of 8 and 7 respectively. No differences in survival benefit were found after day 3. These results were consistent across sensitivity and exploratory analyses.ConclusionThis target trial emulation study suggests that a liberal transfusion threshold may provide a modest survival benefit during the early course of VA-ECMO, but no benefit afterwards. Prospective studies are needed to confirm these findings, assess clinical adoption, and investigate underlying mechanism.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ; ECMO; VA ECMO; Transfusion threshold; Target trial emulation |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie) |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 27 Mar 2026 05:37 |
| Last Modified: | 27 Mar 2026 05:37 |
| URI: | https://pred.uni-regensburg.de/id/eprint/67967 |
Actions (login required)
 |
View Item |
