The relationship between hemoglobin level and prognosis in patients under VV ECMO support
Bibliographic record
Abstract
Background: Emerging evidence suggests that restrictive transfusion strategies are not inferior to liberal ones in patients receiving venovenous extracorporeal membrane oxygenation (VV ECMO). However, there is no clear consensus on how low hemoglobin concentrations or transfusion thresholds can safely be reduced in this population, especially amid increasing blood product shortages. This study aimed to explore the prognostic impact of lower hemoglobin concentrations and transfusion thresholds in VV ECMO patients by analyzing clinical outcomes across stratified groups. Methods: We conducted a retrospective cohort study of patients who received VV ECMO support in the Department of Intensive Care Medicine at the First Affiliated Hospital of Guangzhou Medical University between January 1, 2015, and May 31, 2024. Hemoglobin concentrations and transfusion thresholds were calculated using time-weighted averages. Patients were stratified into four groups based on hemoglobin concentrations and transfusion thresholds. The primary outcome was 60-day mortality following ECMO initiation. Secondary outcomes included ECMO weaning success rate, in-hospital mortality, and total red blood cell (RBC) transfusion volume. Results: A total of 182 patients were included. Of these, 112 (64.54%) were successfully weaned from ECMO within 60 days, 76 (41.76%) died within 60 days, and 97 (53.30%) died during hospitalization. The median RBC transfusion volume during ECMO was 20 units (IQR: 10–38.75). Compared to the ≥90 g/L hemoglobin group, only the <70 g/L group showed significantly higher 60-day mortality (HR 3.85, 95% CI: 1.07–13.79, P = 0.039). ECMO weaning success rates were lower in the <70 g/L, 70–80 g/L, and 80–90 g/L groups. Among the 177 patients (97.25%) who received RBC transfusions, those with transfusion thresholds <60 g/L had significantly higher 60-day mortality compared to the ≥80 g/L group (HR 3.76, 95% CI: 1.23–11.48, P = 0.020). Conclusions: In VV ECMO patients, hemoglobin concentrations <70 g/L are associated with increased 60-day mortality, and ECMO weaning success rates decline progressively with lower hemoglobin levels. Similarly, transfusion thresholds <60 g/L are linked to higher mortality compared to liberal strategies (≥80 g/L). These findings suggest that extreme reductions in transfusion thresholds may compromise outcomes and highlight the need for individualized transfusion strategies in ECMO management. Keywords: Venovenous Extracorporeal Membrane Oxygenation, Hemoglobin, Anemia, Red Blood Cell Transfusion, Transfusion Thresholds
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".