Discussion
death, critically ill, illness, hypoxia, respiratory failure, cardiac failure increase
MASSIVE HEMORRHAGE, HYPOXIA, RESPIRATORY FAILURE, CRITICALLY ILL
ECMO treatments are predominantly high-risk, high-cost, and often ethically debatable [The occurrence of NRBCs in the peripheral blood is pathophysiological due to a higher erythropoietic pressure and the failure of the spleen to clear these precursor cells. Since circumstances such as systemic inflammatory reactions, hypoxia, massive hemorrhage, and cardiac failure increase erythropoietic pressure, the appearance of NRBCs indicates a disturbance of homeostasis [Stachon et al. pointed out the prognostic significance in patients who underwent cardiothoracic surgery [In our study, patients in the acute phase of illness with cardiocirculatory and/ or respiratory failure requiring ongoing extracorporeal support were studied. Piggott et al. demonstrated an NRBCs’ increase greater than 50% after ECMO decannulation in children was associated with higher inpatient mortality (OR 17.1, 95% CI 3.1–95.1, When evaluating the cutoff for NRBCs we saw a 39 times greater risk for death when NRBCs reached or passed 270 µl. Furthermore, the ROC curve of NRBCs under ECMO therapy reached an AUC of 0.85. In addition, significantly higher levels of nucleated red blood cells were detected in the blood of the deceased patients. In summary, all this indicates NRBCs as a very strong predictor for mortality in critically ill patients independent of the ECMO mode. Besides, it is an advantage that NRBCs can be routinely determined every day. It is easily available and low of cost.As a part of future investigations, we would like to incorporate NRBC count, respectively, a defined cutoff in a clinical mortality score. There are some existing mortality scores like EuroSCORE II for cardiothoracic patients [Even though we only included a small number of cases in our study, there is a very strong trend that this parameter is suitable to measure mortality in the context of ECMO therapy.With a routine daily review of NRBCs implemented into a scoring system, perhaps a flexible tool could be created to evaluate the patients’ process and give physicians a chance to take a closer look at the patient before further deterioration occurs. While further large prospective studies have yet to demonstrate whether NRBCs can serve as a marker to detect mortality independent of ECMO mode, based on our results, we can say that while NRBCs are not new in business, they appear to be old but gold.