Restrictive Versus Liberal Thresholds for Red Blood Cell Transfusion in ExtraCorporeal Membrane Oxygenation - the TREC Study

What this Trial Is About

Researchers are evaluating red blood cell (RBC) transfusion strategies in adult patients receiving extracorporeal membrane oxygenation (ECMO), a life-support method for severe heart or lung failure. The study compares whether a restrictive transfusion threshold (lower hemoglobin level trigger) is as safe as a more liberal threshold regarding 90-day survival. This trial addresses the lack of evidence-based guidelines for RBC transfusions in ECMO patients, aiming to improve transfusion practices and outcomes while considering risks and resource scarcity. Participants are randomly assigned to one of two strategies: the restrictive group receives RBC transfusions when hemoglobin falls to 7.0 g/dL, targeting a range of 7.1 to 9.0 g/dL, while the liberal group receives transfusions at a threshold of 9.0 g/dL, targeting 9.1 to 11.0 g/dL. Transfusions are given one unit at a time, with hemoglobin levels checked within hours after each. This prospective, multi-center randomized trial monitors these strategies over the course of ECMO treatment. Throughout the study, participants' health status, transfusion volumes, reasons for transfusions, and complications are carefully recorded. Outcomes include 90-day mortality, hospital and ICU stay lengths, morbidity in the ICU, quality of life assessments, and healthcare costs up to one year. Regular questionnaires and medical consumption surveys are conducted at 3, 6, 9, and 12 months. The study will provide crucial data on the safety and resource implications of different transfusion thresholds in this vulnerable group.

Restrictive Versus Liberal Thresholds for RBC Transfusion in ECMO