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A value-based approach to optimize red blood cell transfusion in patients receiving extracorporeal membrane oxygenation.
- Source :
-
Perfusion . Nov2023, Vol. 38 Issue 8, p1682-1687. 6p. - Publication Year :
- 2023
-
Abstract
- Introduction: The risk, cost, and adverse outcomes associated with packed red blood cell (RBC) transfusions in patients with cardiopulmonary failure requiring extracorporeal membrane oxygenation (ECMO) have raised concerns regarding the overutilization of RBC products. It is, therefore, necessary to establish optimal transfusion criteria and protocols for patients supported with ECMO. The goal of this study was to establish specific criteria for RBC transfusions in patients undergoing ECMO. Methods: This was a retrospective cohort study conducted at Stanford University Hospital. Data on RBC utilization during the entire hospital stay were obtained, which included patients aged ≥18 years who received ECMO support between 1 January 2017, and 30 June 2020 (n = 281). The primary outcome was in-hospital mortality. Results: Hemoglobin (HGB) levels >10 g/dL before transfusion did not improve in-hospital survival. Therefore, we revised the HGB threshold to ≤10 g/dL to guide transfusion in patients undergoing ECMO. To validate this intervention, we prospectively compared the pre- and post-intervention cohorts for in-hospital mortality. Post-intervention analyses found 100% compliance for all eligible records and a decrease in the requirement for RBC transfusion by 1.2 units per patient without affecting the mortality. Conclusions: As an institution-driven value-based approach to guide transfusion in patients undergoing ECMO, we lowered the threshold HGB level. Validation of this revised intervention demonstrated excellent compliance and reduced the need for RBC transfusion while maintaining the clinical outcome. Our findings can help reform value-based healthcare in this cohort while maintaining the outcome. [ABSTRACT FROM AUTHOR]
- Subjects :
- *LENGTH of stay in hospitals
*HOSPITALS
*HEMOGLOBINS
*CONFIDENCE intervals
*EXTRACORPOREAL membrane oxygenation
*RETROSPECTIVE studies
*VALUE-based healthcare
*HOSPITAL mortality
*PRE-tests & post-tests
*T-test (Statistics)
*HOSPITAL care
*CHI-squared test
*DESCRIPTIVE statistics
*RED blood cell transfusion
*LOGISTIC regression analysis
*DATA analysis software
*ODDS ratio
*LONGITUDINAL method
Subjects
Details
- Language :
- English
- ISSN :
- 02676591
- Volume :
- 38
- Issue :
- 8
- Database :
- Academic Search Index
- Journal :
- Perfusion
- Publication Type :
- Academic Journal
- Accession number :
- 173276163
- Full Text :
- https://doi.org/10.1177/02676591221128138