Duration of Red-Cell Storage and Complications after Cardiac Surgery

Koch, Colleen G.; Li, Liang; Sessler, Daniel I.; Figueroa, Priscilla; Hoeltge, Gerald A.; Mihaljević, Tomislav; Blackstone, Eugene H.

doi:10.1056/nejmoa070403

Cited by 1,244 publications

(1,173 citation statements)

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“…Prolonged storage of transfused red blood cells appears to provoke numerous serious postoperative morbidities along with mortality. 26 Exclusion of patients with missing information (the complete-case approach) can also result in substantial bias and underestimate risks of patients because excluded patients may have the highest comorbidities and thus be at highest risk of mortality. To estimate the contribution of this potential bias, we calculated the mortality rates in excluded and included patients and found the rates to be similar.…”

Section: Limitationsmentioning

confidence: 99%

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Turan

Yang

Bonilla

et al. 2013

Can J Anesth/J Can Anesth

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Background Massive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality.Methods We evaluated 971,455 patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We assessed the associations between 30-day mortality and baseline, intraoperative, and postoperative factors among 5,143 patients who received massive transfusions and for whom complete data were available. Results The crude 30-day postoperative mortality of the non-transfused, low transfusion (1-4 units), and massive transfusion (C 5 units) patients in the NSQIP was 1.2%, 8.9%, and 21.5%, respectively. Of the 5,143 massive transfusion patients with non-missing covariable data, 17% (95% confidence interval [CI] 16% to 18%) died within 30 days of surgery, while 54% (95% CI 53% to 56%) had at least one non-fatal major complication. The following baseline and intraoperative variables were independently associated with 30-day mortality after adjusting for multiple testing: age, American Society of Anesthesiologists (ASA) physical status, emergency case, surgical types, coma [ 24 hr before surgery, systemic sepsis, preoperative international normalized ratio of prothrombin time, the number of intraoperative transfusions, and requirement of postoperative transfusion. Conclusion Massive transfusion is associated with substantial risk for respiratory and infectious complications and for mortality. Patients who died within 30 days of a massive perioperative transfusion were generally older, more likely to have vascular surgical procedure and abnormal international normalized ratio of prothrombin time, higher ASA physical status, preoperative coma and sepsis, and higher postoperative bleeding requiring transfusion, and they were likely given more intraoperative red cell units. RésuméContexte Les transfusions massives sont associées à des taux élevés de morbidité et de mortalité; toutefois, les Presented in part at the Foundation for Anesthesia Education and Research session at the

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Section: Limitationsmentioning

confidence: 99%

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Turan

Yang

Bonilla

et al. 2013

Can J Anesth/J Can Anesth

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“…4,5 Experimental studies have shown that both hypoxic and nonhypoxic mechanisms may contribute to anemia-induced organ injury and mortality. 3,6,7 The complex nature of the cellular mechanisms involved may explain why anemiainduced mortality is not necessarily improved by therapies which increase blood oxygen content, including red blood cell (RBC) transfusions, 8,9 use of erythropoiesis stimulating agents (ESAs), 10 or hemoglobin-based oxygen carriers (HBOCs). 11 Each of these strategies is capable of increasing blood oxygen content but may not increase tissue oxygen delivery.…”

Section: Résumémentioning

confidence: 99%

Plasma methemoglobin as a potential biomarker of anemic stress in humans

Hare

Romaschin

et al. 2012

Can J Anesth/J Can Anesth

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Purpose Transfusion of allogeneic red blood cells (RBCs) is one of the main treatments of acute anemia secondary to blood loss and fluid resuscitation within the operating room. Decisions to transfuse blood are based largely on intermediate biological markers (hemoglobin, arterial oxygen saturation, blood pressure, heart rate) which may not accurately reflect inadequacy of tissue oxygen delivery.Based on experimental studies, we hypothesized that anemia-induced tissue hypoxia activates adaptive mechanisms which promote local vascular nitric oxide (NO) production to improve tissue perfusion and survival during acute anemia. Hemoglobin (Hb) oxidation to methemoglobin (MetHb) may be a byproduct of such local NO production. Therefore, we tested the hypothesis that MetHb is a biomarker of hypoxic-anemic stress during acute hemodilution associated with cardiopulmonary bypass. Methods With institutional ethics approval, routine laboratory arterial blood gas and co-oximetry values were obtained from 295 patients undergoing heart surgery during February 1 to September 30, 2010, and the values were assessed retrospectively. All samples with an arterial oxygen saturation value C90% were included (n = 1,421). The maximal change in Hb associated with hemodilution on cardiopulmonary bypass was determined within 48 hr of surgery (n = 180). A chart review was performed to determine the incidence of RBC transfusion and exogenous nitrate administration. All anonymous data were analyzed by linear regression to determine the relationship between Author contributions Gregory M.T. Hare designed the research, performed the research, contributed novel intellectual input, analyzed the data, and wrote the paper. Alexander Mu performed the research, contributed novel intellectual input, and analyzed the data. Alexander Romaschin designed the research, performed the research, contributed novel intellectual input, and analyzed the data. Nadine Shehata designed the research, performed the research, contributed novel intellectual input, and analyzed the data. W. Scott Beattie designed the research, performed the research, contributed novel intellectual input, analyzed the data, and wrote the paper. C. David Mazer designed the research, performed the research, contributed novel intellectual input, analyzed the data, and wrote the paper. Albert K.Y. Tsui contributed novel intellectual input, analyzed the data, and wrote the paper. RésuméObjectif La transfusion de globules rouges alloge´niques est l'un des principaux traitements de l'ane´mie aigues econdaire a`une perte sanguine et au remplissage liquidien en salle d'ope´ration. La de´cision de transfuser du sang repose essentiellement sur des marqueurs biologiques interme´diaires (he´moglobine, saturation en oxyge`ne du sang arte´riel, pression arte´rielle, fre´quence cardiaque) qui pourraient ne pas refle´ter avec pre´cision l'insuffisance d'apport d'oxyge`ne aux tissus. A`partir d'e´tudes expe´rimentales nous avons fait l'hypothe`se qu'une hypoxie tissulaire induite par l'ane´mie act...

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“…There is increasing evidence that excessive bleeding requiring transfusions is independently associated with serious perioperative events, such as sepsis, acute respiratory distress syndrome, renal failure, and death. [4][5][6] Surgical causes of bleeding are found in less than 50% of patients undergoing re-operations for bleeding, and it is proposed that microvascular coagulopathy is the most common cause of postoperative hemorrhage. A heparin rebound phenomenon (reappearance of anticoagulant activity after adequate neutralization with protamine) can contribute to this coagulopathy.…”

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confidence: 99%

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

Taneja

Marwaha

Sinha

et al. 2009

Can J Anesth/J Can Anesth

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Duration of Red-Cell Storage and Complications after Cardiac Surgery

Abstract: In patients undergoing cardiac surgery, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival.

Cited by 1,244 publications

References 45 publications

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Plasma methemoglobin as a potential biomarker of anemic stress in humans

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

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