Early red blood cell transfusion burden, hemoglobin at first transfusion, and in-hospital mortality in…

Cohort studyAnnals of intensive care· 2026

Early red blood cell transfusion burden, hemoglobin at first transfusion, and in-hospital mortality in patients supported with veno-arterial ECMO: a multicenter cohort study.

Min Ho Ju, Seulgi Ju, In Seok Jeong … Hee Jung Kim

Transplant & Mechanical SupportCohort studyPrognosisQ1IF 5.9

Receiving 5 or more red blood cell units on ECMO day 1 linked to higher in-hospital mortality

Early red blood cell transfusion burden, hemoglobin at first transfusion, and in-hospital mortality in patients supported with veno-arterial ECMO: a multicenter cohort study.

Min Ho Ju … Hee Jung Kim

Annals of intensive care · 2026

Background

Red blood cell (red blood cell) transfusion is common during venoarterial extracorporeal membrane oxygenation (venoarterial extracorporeal membrane oxygenation), but the prognostic relevance of early cumulative transfusion burden and hemoglobin (Hb) at transfusion initiation remains uncertain.

Methods

The primary analysis used a 24 -h landmark cohort of patients alive and still receiving ECMO beyond 24 h.

n = 2,020 included patients

Results

Patients transfused ≥5 units on day 1 had 48% higher adjusted mortality risk than untransfused patients.

RR 1.08 (95% CI 1.05 to 1.11)

null 1

1.05

1.11

CI excludes the null - significant

More results

Among 2,020 included patients, 1,708 entered the 24-h landmark cohort, and 1,140 complete cases comprised the adjusted primary analysis.

Each 2-unit increase was associated with higher mortality (adjusted RR, 1.08; 95% CI, 1.05-1.11), with concordant findings over ECMO days 1-2 (adjusted RR, 1.06; 95% CI, 1.04-1.08).

More results

Among 1,043 transfused complete cases with qualifying pretransfusion Hb, each 1 g/dL decrease in first-transfusion Hb was associated with higher mortality (adjusted RR, 1.15; 95% CI, 1.10-1.20).

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Conclusion · 1 of 2

In adults receiving peripheral venoarterial extracorporeal membrane oxygenation, early red blood cell transfusion burden showed a graded association with in-hospital mortality, whereas lower first-transfusion Hb was a prognostic marker chiefly within the consistent-threshold phenotype.

Conclusion · 2 of 2

These findings support dose- and threshold-aware prognostic assessment but do not establish causality or define an optimal transfusion threshold.

Early red blood cell transfusion burden, hemoglobin at first transfusion, and in-hospital mortality in patients supported with veno-arterial ECMO: a multicenter cohort study.

Early red blood cell transfusion burden, hemoglobin at first transfusion, and in-hospital mortality in patients supported with veno-arterial ECMO: a multicenter cohort study.

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