TITRE: Trial of Indication-Based Transfusion of Red Blood Cells in ECMO
Abstract
Extracorporeal membrane oxygenation (ECMO) can provide life-saving mechanical cardiac and respiratory support to critically ill children. Survival to hospital discharge is approximately 50 percent in most populations, but adverse events are common and long-term function including quality of life (QOL) is compromised in many ECMO survivors. Children supported with ECMO undergo red blood cell (RBC) transfusions to maintain a threshold hematocrit (HCT) or hemoglobin (Hb) for tissue oxygen delivery (DO2). However, observational studies of children on ECMO have shown an association between large-volume RBC transfusion and mortality. Further, the HCT (or Hb) level at which optimal DO2 occurs is unknown. To address this crucial knowledge gap, we propose TITRE - Trial of Indication-based Transfusion of Red Blood Cells in ECMO, a multicenter, prospective, randomized clinical trial (RCT). The overarching goal of TITRE is to determine whether restricting RBC transfusion according to an indication-based strategy for those with bleeding and/or deficit of tissue oxygen delivery, compared with transfusion based on center-specific Hb or HCT thresholds, can reduce organ dysfunction, and improve later neurodevelopment in critically ill children receiving ECMO support. Relevance to Topic Areas: The proposed research has relevance to the following Topic Areas: Congenital Heart Disease (CHD); Cardiomyopathy; Emerging Viral Pathogens; Pathogen-Inactivated Blood Products; and Hemorrhage Control. CHD is a common birth defect affecting approximately 8 per 1000 live births, many of whom require surgical correction or palliation. Many of the ECMO patients to be enrolled in the proposed RCT will have CHD. Cardiomyopathy is a rare disease, and ECMO can help rescue these patients from life threatening heart failure and serve as a bridge to transplantation.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jul 01, 2023
- Accession Number
- AD1208687
Entities
People
- Lynn A Sleeper