Background/Objectives: The impact of different coronary artery bypass grafting (CABG) strategies, particularly on-pump versus off-pump techniques, on red blood cell (RBC) transfusions and their associated outcomes has not been fully investigated. This study aims to evaluate the association between RBC transfusion and survival in CABG patients, focusing on-pump strategy. Methods: Data from CABG patients were retrieved from the National Health Insurance Service database (2003 to 2019). Perioperative RBC transfusions were classified into three groups: no transfusion, RBC 1, and RBC ≥ 2 units. The primary endpoint was all-cause mortality rate. Subgroup analysis assessed the impact of RBC transfusion on mortality across the conventional on-pump (CCAB) and off-pump (OPCAB) groups. Results: Among the 6150 participants who underwent CABG, 2028 underwent CCAB and 4122 underwent OPCAB. The mean age was 66.2 ± 9.7 years, with a mean follow-up of 2.9 (2.53–3.35) years. Multivariable analysis showed a significant association between transfusion of ≥2 RBC units and increased mortality risk (HR 2.34 [1.65–3.32], p < 0.001). Subgroup analysis showed a similar trend in both CCAB and OPCAB groups (p for interaction = 0.2). Transfusion of ≥2 units significantly increased mortality in OPCAB (HR 2.28 [1.55–3.37], p < 0.001) but not in CCAB (HR 2.96 [0.97–9.06], p = 0.057). OPCAB and surgery at large volume center was associated with a reduced risk of RBC transfusion (p < 0.01). Conclusions: Increased RBC transfusion is associated with higher long-term mortality in patients undergoing CABG. Based on a large cohort predominantly consisting of OPCAB patients, OPCAB is associated with decreased RBC transfusion requirements.

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has the potential to improve neurological outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA), offering an alternative to conventional cardiopulmonary resuscitation (CCPR). However, its effectiveness in OHCA remains controversial despite advancements in resuscitation techniques. Methods: This retrospective single-center study compared neurological outcomes and 30-day survival between ECPR and CCPR patients from January 2014 to January 2022. Patients aged 18–75 with witnessed OHCA, minimal no flow and low flow times, and cardiac arrests occurring at home or in public places were included. All patients were transported directly to our institution, a tertiary medical center serving the southeastern region of Seoul, where extracorporeal membrane oxygenation implantation was consistently performed in the emergency department. Neurological outcomes were assessed using Cerebral Performance Category scores, with good outcomes defined as scores of 1–2. Statistical analyses included logistic regression models and Kaplan–Meier survival curves, adjusted for confounders using inverse probability of treatment weighting. Results: ECPR was associated with significantly better neurological outcomes than CCPR (p < 0.001). Factors predicting poor outcomes included older age and longer low flow times, while male sex and shockable rhythms were protective. No significant difference was found in 30-day survival between the ECPR and CCPR groups, although a trend toward better survival was noted with ECPR. Conclusions: ECPR may improve neurological outcomes in patients with refractory OHCA compared to CCPR, although it does not significantly affect 30-day survival. Further studies are necessary to validate these findings and explore the long-term impacts of ECPR.