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Journal article
Storage duration of packed red blood cells transfused during veno-venous extracorporeal membrane oxygenation is associated with elevated pulmonary artery pressure and lung injury in a sheep model
Critical Care, Vol.29(1), pp.1-16
2025
PMID: 40514712
Abstract
Background
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is associated with a high transfusion burden. While trials have concluded that red blood cell (RBC) storage does not impact patient morbidity and mortality in the critically ill or cardiac surgical cohorts, evidence is sparse for ECMO cohorts. A sheep model was to investigate this question. On an underlying injury of smoke inhalation, we compared fresh (< 5 days) or stored (35–42 days) RBC transfusion with no transfusion. Clinically relevant outcomes included pulmonary artery pressure as well as biochemical or histopathological markers of lung, liver, and renal injury.
Methods
Twenty-four female Merino/Samm Border Leicester Cross sheep were anaesthetised and placed on pressure-controlled ventilation. They were instrumented for continuous haemodynamic monitoring. They then underwent smoke inhalation injury, followed two hours later by veno-venous ECMO. Sheep were randomised to three groups: control (no transfusion (n = 8)), fresh RBC (n = 8) and stored RBC (n = 8) transfusion occurring six hours after ECMO initiation. Blood samples were taken regularly, and 24 h post-ECMO, animals were sacrificed. Post-mortem samples of lung and kidney were collected for post-mortem analyses.
Results
Following ECMO initiation and transfusion, pulmonary artery pressure increased in the stored RBC group. Histopathological analysis also demonstrated a significantly elevated lung injury in this group. This lung injury was characterised by greater extravasation of inflammatory cells as well as bronchiole damage and oedema. Renal histopathology showed no significant differences between groups. Alanine aminotransferase, aspartate aminotransferase and bilirubin levels increased in a time dependent manner post-transfusion but there were no treatment-associated differences. During experimentation, the coagulation profile changed with firmer clots forming more quickly. Differences were observed between both transfusion groups and controls.
Conclusions
Transfusion of stored RBC elevated pulmonary artery pressure when compared to fresh RBC transfusion and controls. This change was correlated with a greater post-transfusion lung injury in the stored RBC group. Further investigation assessing whether insufficient nitric oxide had a role in these findings is warranted, as is consideration of longer ECMO durations and greater transfusion volumes.
Details
- Title
- Storage duration of packed red blood cells transfused during veno-venous extracorporeal membrane oxygenation is associated with elevated pulmonary artery pressure and lung injury in a sheep model
- Authors
- Fergal T Temple (Corresponding Author) - The University of SydneyGabriela Simonova - The University of QueenslandMargaret R Passmore - The University of QueenslandSamuel R Foley - The University of QueenslandSara D Diab - The University of QueenslandKimble R Dunster - Queensland Children’s HospitalCharles I McDonald - The University of QueenslandKiran Shekar - The University of QueenslandYoke-Lin Fung - University of the Sunshine Coast, Queensland, School of Health - BiomedicineJohn-Paul Tung - University of the Sunshine Coast, Queensland, School of Health and Behavioural Sciences - LegacyJohn F Fraser - The University of Queensland
- Publication details
- Critical Care, Vol.29(1), pp.1-16
- Publisher
- BioMed Central Ltd.
- Date published
- 2025
- DOI
- 10.1186/s13054-025-05438-z
- ISSN
- 1466-609X; 1364-8535
- PMID
- 40514712
- Copyright note
- This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
- Data Availability
- The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
- Organisation Unit
- School of Health - Biomedicine; Healthy Ageing Research Cluster; School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 991136299802621
- Output Type
- Journal article
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