Transfusion Threshold and RBC Transfusion Volume: Predictors of Mortality in VA-ECMO Patients – A Systematic Review and Meta-Analysis

초록

Background: Optimal transfusion strategies remain uncertain in VA-ECMO patients. This systematic review and meta-analysis evaluates the impact of transfusion thresholds and RBC transfusion volume per ECMO-day on patient mortality. Methods: A systematic literature search identified relevant studies published from 2015 to 2024. Data from VA-ECMO patients across selected studies were analyzed. A 3D regression model was constructed to examine relationships between transfusion threshold, RBC transfusion volume per ECMO-day, and mortality. Results: The regression analysis demonstrated a significant association between transfusion thresholds and mortality (β=7.39, p<0.05), suggesting mortality increases with higher transfusion thresholds. Conversely, RBC transfusion per ECMO-day was negatively correlated with mortality (β=-2.29, p<0.05), indicating higher RBC transfusion volumes alone were not associated with increased mortality when thresholds were accounted for. The regression model explained approximately 48% of mortality variability (R²=0.48). Conclusion: Transfusion threshold is a significant predictor of mortality in VA-ECMO patients, with higher thresholds correlating with increased mortality. Interestingly, total RBC transfusion volume alone showed an inverse correlation. This emphasizes the need for carefully evaluating transfusion thresholds rather than focusing solely on RBC transfusion volume to improve survival outcomes in VA-ECMO patients.