Impact of massive blood transfusion during adult extracorporeal membrane oxygenation support on long-term outcomes: a nationwide cohort study in Taiwan

Fang Ting Chen, Shao Wei Chen, Victor Chien Chia Wu, Kuo Chun Hung, Shang Hung Chang, Pei Chi Ting, An Hsun Chou

Research output: Contribution to journalJournal Article peer-review

15 Scopus citations


OBJECTIVES: Bleeding is a common problem during adult extracorporeal membranes oxygenation (ECMO) support, requiring blood transfusion for correction of volume depletion and coagulopathy. The goal of this study is to investigate the long-term outcomes for adults under support of ECMO with massive blood transfusion (MBT). DESIGN: Retrospective nationwide cohort study. SETTING: Data were provided from Taiwan National Health Insurance Research Database (NHIRD). PARTICIPANTS AND INTERVENTIONS: Totally 2757 adult patients were identified to receive MBT (red blood cell ≥10 units) during ECMO support from 2000 to 2013 via Taiwan NHIRD. MAIN OUTCOME MEASURES: The outcomes included in-hospital major complications/mortality, all-cause mortality, cardiovascular death, newly onset end-stage renal disease and respiratory failure during the follow-up period. RESULTS: Patients with MBT had higher in-hospital mortality (65.6% vs 52.1%; OR 1.74; 95% CI 1.53 to 1.98) and all-cause mortality during the follow-up (47.0% vs 35.8%; HR 1.46; 95% CI 1.25 to 1.71) than those without MBT. Not only higher incidences of post ECMO sepsis, respiratory failure and acute kidney injury, but also longer duration of ECMO support, ventilator use and intensive care unit stay were demonstrated in the MBT group. Moreover, a subdistribution hazard model presented higher cumulative of respiratory failure (19.8% vs 16.2%; subdistribution HR 1.36; 95% CI 1.07 to 1.73) for the MBT cohort. Positive dose-dependent relationship was found between the amount of transfused red blood cell product and in-hospital mortality. In the MBT subgroup analysis for the impact of transfused ratio (fresh frozen plasma/packed red blood cell) on in-hospital mortality, ratio ≥1.0 had higher mortality. CONCLUSIONS: Patients with MBT during ECMO support had worse long-term outcomes than non-MBT population. The transfused amount of red blood cell had positive dose-dependent effect on in-hospital mortality.

Original languageEnglish
Pages (from-to)e035486
JournalBMJ Open
Issue number6
StatePublished - 23 06 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.


  • adult intensive & critical care
  • blood bank & transfusion medicine
  • heart failure


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