Association Between Red Blood Cells Transfusion and 1 Year Mortality in Patients on Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

In patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock, red blood cell (RBC) transfusion is often necessary, but its impact on long-term mortality remains unclear. This multicenter retrospective cohort study aimed to assess the association between RBC transfusion and 1 year mortality in patients on VA-ECMO. Data were collected from two French intensive care units (ICUs) between January 1 st , 2016, and December 31 st , 2021. Adults with cardiogenic shock supported by VA-ECMO were included, while those under 18, with ECMO duration <24 hours, or cardiac arrest before or during implantation were excluded. Among 190 patients (71% male, median age 60 years), the median VA-ECMO duration was 8 days. One year mortality was 54%. Red blood cell transfusions were administered to 83% of patients, with a median of six packs. Multivariable analysis showed no significant association between RBC transfusion and 1 year mortality across various transfusion metrics, including transfusion status, total units, and daily packs (all p > 0.05). Subgroup analyses confirmed this consistent pattern. Although RBC transfusion is frequent in VA-ECMO-supported patients, this study found no significant association with 1 year survival. Given the risks of transfusion, a cautious approach is recommended. Further studies are needed to refine transfusion strategies for this high-risk population.