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Modelo de transfusão em suporte de oxigenação extracorporal : ensinamentos de 10 anos de prática
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Objetivo: Avaliar um método restritivo de transfusão nas crianças submetidas a Oxigenação Extracorporal. Métodos: Estudo descritivo e retrospetivo em doentes pediátricos sob ECMO, admitidos na Unidade de Cuidados Intensivos Pediátricos de um hospital universitário, entre maio 2010 e outubro 2019. Foram registados os valores de hemoglobina, lactato, saturação venosa mista e complicações hemorrágicas de cada doente. Os valores prétransfusão foram estatisticamente comparados com os valores pós-transfusão. Comparouse o valor médio de hemoglobina pré-transfusão nos primeiros anos com o mesmo valor dos últimos anos. Resultados: Num total de 64 suportes de ECMO, analisaram-se 54 suportes, correspondentes a 53 doentes (excluídos 10 suportes por os doentes terem sido submetidos a cirurgia major sob ECMO). Obteve-se uma idade mediana de 24,5 dias (0 dias; 17 anos), com predominância de recém-nascidos 28 (53%) e de doentes do sexo masculino 29 (54%). Utilizou-se ECMO venoarterial em 36 (67%) dos suportes. De um total de 1016 análises, obteve-se um valor médio de hemoglobina pré-transfusão de 8,6±1,6 g/dl g/dl. O doente apresentava hemorragia ativa em 64,2% das análises. Houve um aumento significativo de Hb e de SvmO2 (p<0,005) pós-transfusão, mas não se verificou uma descida significativa no valor dos lactatos. Foram transfundidos 41 (89%) dos doentes com Hb<7g/dL. Nas análises com Hb<12g/dl, recuperaram 73,5% doentes sem necessidade de transfusão. A presença de hemorragia ativa foi fator decisivo de transfusão para valores Hb>7g/dl (p-value<0,001). Em retrospetiva, o valor de Hb pré transfusão diminuiu de 9,3±1,5g/dl (nos primeiros 6 anos) para 7,98±1,4g/dl (nos últimos 4 anos) (p <0,005). Sobreviveram 35 doentes (66%). Conclusões: Hb < 7 g/dL foi o cut-off de decisão para transfusão, concluindo-se que este centro adota um método restritivo de transfusão. Mais estudos serão necessários para garantir a segurança dos doentes e propor a alteração às atuais orientações sobre transfusão em ECMO.
Objectives: This study aims to evaluate a restrictive red blood cell transfusion policy in children submitted to Extracorporeal Membrane Oxigenation. Methods: Retrospective descriptive study of pediatric patients supported with ECMO, admitted to the Pediatric Intensive Care Unit of a universitary hospital, from May 2010 to October 2019. Hemoglobin, lactate, mixed venous saturation values and bleeding complications of each patient were recorded. Pre-transfusion values were statistically compared with post-transfusion values. A comparison was made between mean hemoglobin value pre-transfusion in the first years and in the last years. Results: Of the total of 64 ECMO support, 54 were analyzed (10 were excluded because the patients underwent surgery on ECMO): median age 24,5 days (0 days; 17 years); the majority being newborns, 28 (53%), and male patients, 29 (54%). Venoarterial ECMO was used in 36 (67%) ECMO support. From a total of 1016 analyzed hemoglobin values, the average value for transfusion was 8,6±1,6g/dl. Active bleeding was present in 64,2% of patient samples. Hemoglobin and mix venous saturation values increased after transfusion (p<0,005), but there was not a significant decrease in lactate. Between patients with Hb < 7g/dl, 41 (89%) were transfused. Patients samples with Hb<12g/dl, 73,5% recovered without blood support need. The presence of active bleeding was a decisive factor for transfusion, especially with Hb>7g/dl (p-value<0,001). Over the years, the average Hb value used for transfusion statistically decreased from 9,3±1,5 g/dl (first six years) to 7,98±1,4 g/dl (last four years) (p <0,005). Overall, 35 patients survived (64%). Conclusion: The cut-off Hb value for RBC transfusions was 7g/dL, which means this center adopts a restrictive method for transfusion. Further studies are needed to ensure patients safety in order to propose changes in current guidelines for RBC transfusion on ECMO.
Objectives: This study aims to evaluate a restrictive red blood cell transfusion policy in children submitted to Extracorporeal Membrane Oxigenation. Methods: Retrospective descriptive study of pediatric patients supported with ECMO, admitted to the Pediatric Intensive Care Unit of a universitary hospital, from May 2010 to October 2019. Hemoglobin, lactate, mixed venous saturation values and bleeding complications of each patient were recorded. Pre-transfusion values were statistically compared with post-transfusion values. A comparison was made between mean hemoglobin value pre-transfusion in the first years and in the last years. Results: Of the total of 64 ECMO support, 54 were analyzed (10 were excluded because the patients underwent surgery on ECMO): median age 24,5 days (0 days; 17 years); the majority being newborns, 28 (53%), and male patients, 29 (54%). Venoarterial ECMO was used in 36 (67%) ECMO support. From a total of 1016 analyzed hemoglobin values, the average value for transfusion was 8,6±1,6g/dl. Active bleeding was present in 64,2% of patient samples. Hemoglobin and mix venous saturation values increased after transfusion (p<0,005), but there was not a significant decrease in lactate. Between patients with Hb < 7g/dl, 41 (89%) were transfused. Patients samples with Hb<12g/dl, 73,5% recovered without blood support need. The presence of active bleeding was a decisive factor for transfusion, especially with Hb>7g/dl (p-value<0,001). Over the years, the average Hb value used for transfusion statistically decreased from 9,3±1,5 g/dl (first six years) to 7,98±1,4 g/dl (last four years) (p <0,005). Overall, 35 patients survived (64%). Conclusion: The cut-off Hb value for RBC transfusions was 7g/dL, which means this center adopts a restrictive method for transfusion. Further studies are needed to ensure patients safety in order to propose changes in current guidelines for RBC transfusion on ECMO.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Suporte de vida extracorporal Hemoglobina Lactatos Saturação venosa mista Transfusão Pediatria