key: cord-0751577-9spyx5wc
authors: Ramanathan, Kollengode; MacLaren, Graeme; Combes, Alain; Brodie, Daniel; Shekar, Kiran
title: Blood transfusion strategies and ECMO during the COVID-19 pandemic – Authors' reply
date: 2020-04-16
journal: Lancet Respir Med
DOI: 10.1016/s2213-2600(20)30174-0
sha: 6e4625be240af37dcc67258a4acba37c5b676e58
doc_id: 751577
cord_uid: 9spyx5wc

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A recent global survey on transfusion requirements during venovenous ECMO, 2 with more than 400 respondents from 42 countries, showed institutional variations in transfusion practices. Of note, the transfusion trigger was significantly lower in high-volume ECMO centres (>24 cases per year) because they followed protocol-based transfusion practices and accepted lower haemoglobin levels, as compared with low-volume centres (<12 cases per year). 2 We believe that the majority of patients with COVID-19 who require ECMO could be treated with venovenous ECMO, and lower trigger thresholds (eg, 7 g/dL) would be tolerated if they are stable and not actively bleeding. 5 ECMO for such patients should be offered in experienced centres in line with WHO guidelines. Higher thresholds (eg, 8-10 g/dL) could be considered in patients with shock or evidence of impaired oxygen delivery despite ECMO. Efforts to maintain physiological haemoglobin levels during ECMO should not be done routinely; transfusion protocols with lower triggers coupled with blood preservation strategies (eg, autotransfusion of circuit blood during decannulation) 5 should reduce blood transfusion in patients with COVID-19 needing ECMO support.

KR is a member of the Extracorporeal Life Support Organization (ELSO) ECMO Educational Task Force (ECMOed) and ELSO's data review committee and scientific overview committee. GM is a member of the executive committee of ELSO. AC reports grants and personal fees from Getinge and Baxter; he was president of EuroELSO and is a member of the executive and scientific committees of the International ECMO Network (ECMONet). DB is on the medical advisory boards for Breethe, Xenios, and Hemovent, and is a past medical advisory board member for Baxter and ALung Technologies; he is currently on the trial steering committee for the VENT-AVOID trial sponsored by ALung Technologies; he is a member of the board of directors of ELSO and is chairman of the executive committee of ECMONet. KS is a member of the ECMONet scientific committee, the Asia-Pacific ELSO educational committee, and Australia and New Zealand's Intensive Care Society COVID-19 working group; he is also the lead of an ECMOed research working group.

Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

Hemoglobin trigger and approach to red blood cell transfusions during veno-venous extracorporeal membrane oxygenation: the international TRAIN-ECMO survey

Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome

Transfusion management during extracorporeal support

Extracorporeal Life Support Organization

Blood conservation in extracorporeal membrane oxygenation for acute respiratory distress syndrome