Effect of age of transfused red blood cells on neurologic outcome following traumatic brain injury (ABLE-tbi Study): a nested study of the Age of Blood Evaluation (ABLE) trial

Ruel-Laliberté, Jessica; Bonaventure, Paule Lessard; Fergusson, Dean; Lacroix, Jacques; Zarychanski, Ryan; Lauzier, François; Tinmouth, Alan; Hébert, Paul C.; Green, Robert C.; Griesdale, Donald; Fowler, Robert; Kramer, Andreas H.; McIntyre, Lauralyn; Zygun, David; Walsh, Tim; Stanworth, Simon; Capellier, Gilles; Pili-Floury, Sébastien; Samain, Emmanuel; Clayton, Lucy; Marshall, John C.; Pagliarello, Giuseppe; Sabri, Elham; Neveu, Xavier; Léger, Caroline; Turgeon, Alexis F.

doi:10.1007/s12630-019-01326-7

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…RBC transfusion has been repeatedly shown to be an effective treatment for increasing cerebral oxygenation. 20 , 25 , 26 , 30 However, it is unclear how much of the repleted oxygenation permeates the reversibly injured penumbra versus the rest of the uninjured cerebral tissue, and, moreover, RBC transfusions come with well-documented risks. The ideal transfusion threshold must maximize the clinical benefits while limiting exposure to the potential negative side effects.…”

Section: Discussionmentioning

confidence: 99%

Transfusion Guidelines in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of the Currently Available Evidence

Montgomery

Barrie

Kenfack

et al. 2022

Neurotrauma Reports

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Our study aims to provide a synthesis of the best available evidence on the hemoglobin (hgb) red blood cell (RBC) transfusion thresholds in adult traumatic brain injury (TBI) patients, as well as describing the risk factors and outcomes associated with RBC transfusion in this population. A systematic review and meta-analysis was conducted using PubMed, Google Scholar, and Web of Science electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess articles discussing RBC transfusion thresholds and describe complications secondary to transfusion in adult TBI patients in the perioperative period. Fifteen articles met search criteria and were reviewed for analysis. Compared to non-transfused, TBI patients who received transfusion tended to be primarily male patients with worse Injury Severity Score (ISS) and Glasgow Coma Scale. Further, the meta-analysis corroborated that transfused TBI patients are older ( p = 0.04), have worse ISS scores ( p = 0.001), receive more units of RBCs ( p = 0.02), and have both higher mortality ( p < 0.001) and complication rates ( p < 0.0001). There were no differences identified in rates of hypertension, diabetes mellitus, and Abbreviated Injury Scale scores. Additionally, whereas many studies support restrictive (hgb <7 g/dL) transfusion thresholds over liberal (hgb <10 g/dL), our meta-analysis revealed no significant difference in mortality between those thresholds ( p = 0.79). Current Class B/C level III evidence predominantly recommends against a liberal transfusion threshold of 10 g/dL for TBI patients (Class B/C level III), but our meta-analysis found no difference in survival between groups. There is evidence suggesting that an intermediate threshold between 7 and 9 g/dL, reflecting the physiological oxygen needs of cerebral tissue, may be worth exploring.

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Section: Discussionmentioning

confidence: 99%

Transfusion Guidelines in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of the Currently Available Evidence

Montgomery

Barrie

Kenfack

et al. 2022

Neurotrauma Reports

View full text Add to dashboard Cite

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“…However, the studies included were judged to be at moderate to high risk of bias and were moderate to low in quality. The age of transfused red blood cells does not appear to be an important factor, with the use of fresh red cells (aged ≤7 days) not being shown to improve neurological outcome [22]. Prospective RCTs are needed in order to determine the optimal transfusion trigger, which should ideally include the effect of transfusion on direct cerebral measures such as brain tissue oxygenation.…”

Section: Red Blood Cell Transfusion and Erythropoietinmentioning

confidence: 99%

Management of traumatic brain injury: a narrative review of current evidence

Wiles

2022

Anaesthesia

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Globally, approximately 70 million people sustain traumatic brain injury each year and this can have significant physical, psychosocial and economic consequences for patients, their families and society. The aim of this review is to provide clinicians with a summary of recent studies of direct relevance to the management of traumatic brain injury in order to promote best clinical practice. The use of tranexamic acid in the management of traumatic brain injury has been the focus of several studies, with one large randomised controlled trial suggesting a reduction in all-cause mortality within 24 h of injury. The use of therapeutic hypothermia does not improve neurological outcomes and maintenance of normothermia remains the optimal management strategy. For seizure management, levetiracetam appears to be as effective as phenytoin, but the optimal dose remains unclear. There has been a lack of clear outcome benefit for any individual osmotherapy agent, with no difference in mortality or neurological recovery. Early tracheostomy (< 7 days from injury) for patients with traumatic brain injury is associated with a reduction in the incidence of ventilator-associated pneumonia and duration of mechanical ventilation, critical care and hospital stay. Further research is needed in order to determine the optimal package of care and interventions. There is a need for research studies to focus on patient-centred outcome measures such as long-term neurological recovery and quality of life.

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“…More than 10 million people worldwide experience TBI each year [ 5 ]. Most patients with TBI also have anemia, and more than one-third receive red blood cell (RBC) transfusions in the intensive care unit (ICU) [ 6 ]. Hypertensive ICH is one of the most severe complications of hypertension, with an incidence of 9–28% in Europe and the United States and 19–48% in China [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Red blood cell transfusion in neurocritical patients: a systematic review and meta-analysis

Yu,

Fu,

et al. 2024

BMC Anesthesiol

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Background Anemia can lead to secondary brain damage by reducing arterial oxygen content and brain oxygen supply. Patients with acute brain injury have impaired self-regulation. Brain hypoxia may also occur even in mild anemia. Red blood cell (RBC) transfusion is associated with increased postoperative complications, poor neurological recovery, and mortality in critically ill neurologic patients. Balancing the risks of anemia and red blood cell transfusion-associated adverse effects is challenging in neurocritical settings. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE (PubMed) from inception to January 31, 2024. We included all randomized controlled trials (RCTs) assessing liberal versus restrictive RBC transfusion strategies in neurocritical patients. We included all relevant studies published in English. The primary outcome was mortality at intensive care unit (ICU), discharge, and six months. Results Of 5195 records retrieved, 84 full-text articles were reviewed, and five eligible studies were included. There was no significant difference between the restrictive and liberal transfusion groups in ICU mortality (RR: 2.53, 95% CI: 0.53 to 12.13), in-hospital mortality (RR: 2.34, 95% CI: 0.50 to 11.00), mortality at six months (RR: 1.42, 95% CI: 0.42 to 4.78) and long-term mortality (RR: 1.22, 95% CI: 0.64 to 2.33). The occurrence of neurological adverse events and most major non-neurological complications was similar in the two groups. The incidence of deep venous thrombosis was lower in the restrictive strategy group (RR: 0.41, 95% CI: 0.18 to 0.91). Conclusions Due to the small sample size of current studies, the evidence is insufficiently robust to confirm definitive conclusions for neurocritical patients. Therefore, further investigation is encouraged to define appropriate RBC transfusion thresholds in the neurocritical setting.

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Effect of age of transfused red blood cells on neurologic outcome following traumatic brain injury (ABLE-tbi Study): a nested study of the Age of Blood Evaluation (ABLE) trial

Cited by 5 publications

References 22 publications

Transfusion Guidelines in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of the Currently Available Evidence

Transfusion Guidelines in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of the Currently Available Evidence

Management of traumatic brain injury: a narrative review of current evidence

Red blood cell transfusion in neurocritical patients: a systematic review and meta-analysis

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