Evidence map›Paper›PMID 40826421›Full record

Observational studyCritical care (London, England)2025

Liberal or restrictive transfusion for veno-arterial extracorporeal membrane oxygenation patients: a target trial emulation using the OBLEX study data.

Le Thi Phuong Thao, Hergen Buscher, Tri-Long Nguyen, Gennaro Martucci, Johannes Gratz, Georg Trummer, Matthieu Schmidt, Melchior Gautier, Alexis Serra, Koji Takeda and 23 more

Registry-linked trialAbstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03714048 (International Observational Study on BLood Management for Mechanical Circulatory Support Using Extracorporeal Membrane Oxygenation), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03714048 completednot on this map

International Observational Study on BLood Management for Mechanical Circulatory Support Using Extracorporeal Membrane Oxygenation (OBLEX)

Typeobservational_patient_registrySponsorSt Vincent's Hospital, SydneyRan2019 to 2023Enrolled561ConditionsDeath, Sudden, Cardiac, HEART ARREST, Shock, Cardiogenic, Arrhythmias, Cardiac
3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Observational
  3. Review
  4. Article
  5. Article
  6. Crossing the line: blood transfusion thresholds in ECMO.Critical care (London, England) · 2025
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

33 authors.

Le Thi Phuong ThaoSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. thao.le@monash.edu.ORCID http://orcid.org/0000-0001-9661-6835
Hergen BuscherSt. Vincent's Hospital Sydney, University of New South Wales, Sydney, NSW, Australia.
Tri-Long NguyenSection of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Gennaro MartucciDepartment of Anesthesia and Intensive Care, Istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy.
Johannes GratzDepartment of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Georg TrummerDepartment of Emergency Medicine, Medical Center-University of Freiburg, Medical Faculty-University of Freiburg, Freiburg, Germany.
Matthieu SchmidtService de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France.
Melchior GautierService de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France.
Alexis SerraASPIRE Trials Program, Division of Pulmonary, Critical Care, and Sleep Medicine, New York University, New York, NY, USA.
Koji TakedaDivision of Cardiothoracic and Vascular Surgery, College of Physicians and Surgeons, NewYork-Presbyterian Hospital, Columbia University, New York, USA.
Jan-Steffen PoothDepartment of Emergency Medicine, Medical Center-University of Freiburg, Medical Faculty-University of Freiburg, Freiburg, Germany.
Kevin RahnDepartment of Emergency Medicine, Medical Center-University of Freiburg, Medical Faculty-University of Freiburg, Freiburg, Germany.
Florian GeismannDepartment of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
Matthias LubnowDepartment of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
Andrew RetterGuy's and St. Thomas' NHS Foundation Trust, London, UK.
Priya NairSt. Vincent's Hospital Sydney, University of New South Wales, Sydney, NSW, Australia.
Ruan VlokRoyal North Shore Hospital, University of NSW, Sydney, Australia.
Maithri SiriwardenaAdult Intensive Care Services, The Prince Charles Hospital, Chermside, QLD, Australia.
James WinearlsIntensive Care, Gold Coast University Hospital, Gold Coast, University of Queensland, Brisbane, QLD, Australia.
James WalshamIntensive Care, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.
David GattasIntensive Care Service, Royal Prince Alfred Hospital, Sydney Medical School, University of Sydney, Camperdown, Australia.
Anders AnemanIntensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia.
Bentley FulcherAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Sally NewmanSt. Vincent's Hospital Sydney, University of New South Wales, Sydney, NSW, Australia.
Claire ReynoldsUniversity of Sydney, Camperdown, Australia.
Anthonio ArcadipaneDepartment of Anesthesia and Intensive Care, Istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy.
Kiran ShekarAdult Intensive Care Services, The Prince Charles Hospital, Chermside, QLD, Australia.
Carol HodgsonAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Vincent PellegrinoDepartment of Intensive Care, The Alfred Hospital, Melbourne, Australia.
Thomas MuellerDepartment of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
Daniel BrodieDepartment of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Zoe McQuiltenSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
International ECMO Network (ECMONet)

Funding

Australian National Health and Medical Research Council's Synergy Grants 1189490Australian National Medical Health and Research Council (NHMRC) Emerging Leader Investigator grant GNT1194811
6 · The paper itself

Abstract

backgroundThe optimal transfusion threshold for patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains uncertain.

methodsWe used data from OBLEX (ClinicalTrials.gov: NCT03714048), an international, prospective, observational study conducted across 12 centres in Australia, Europe, and North America between 2019 and 2022. The study collected information on patient demographics, bleeding risk factors, transfusion practices during the first seven days of ECMO, and in-hospital mortality. Using these data, we emulated a target trial comparing the effects of liberal transfusion practice (transfusion initiated at Hb ≥ 90 g/L) and restrictive transfusion practice (transfusion initiated at Hb ≤ 70 g/L) on hospital mortality within seven days of ECMO initiation. Sequential trials approach was used to estimate the causal contrast.

resultsA total of 534 patients were included, with 46% dying during hospitalisation. After accounting for potential confounders, the liberal transfusion practice demonstrated a modest survival benefit within the first two days of ECMO, with differences in survival probabilities of 12% (95% CI 3% to 21%) at day 2 and 13% (95% CI 2% to 25%) at day 3, corresponding to the number needed to treat (NNT) of 8 and 7 respectively. No differences in survival benefit were found after day 3. These results were consistent across sensitivity and exploratory analyses.

conclusionThis target trial emulation study suggests that a liberal transfusion threshold may provide a modest survival benefit during the early course of VA-ECMO, but no benefit afterwards. Prospective studies are needed to confirm these findings, assess clinical adoption, and investigate underlying mechanism.

Indexed as

Blood TransfusionExtracorporeal Membrane OxygenationAdultAgedAustraliaEuropeFemaleHospital MortalityHumansMaleMiddle AgedNorth AmericaProspective StudiesECMOTarget trial emulationTransfusion thresholdVA ECMO

Identifiers

PMID40826421
PMCPMC12359932

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.