The Association Between Duration of Storage of Transfused Red Blood Cells and Morbidity and Mortality After Reoperative Cardiac Surgery: Retracted

Abstract

Red blood cells (RBCs) undergo numerous changes during storage; however, the clinical relevance of these storage "lesions" is unclear. We hypothesized that the duration of storage of transfused RBCs is associated with mortality after repeat sternotomy for cardiac surgery, because these patients are at high risk for both RBC transfusion and adverse outcome. We retrospectively analyzed 434 patients who underwent repeat median sternotomy for coronary artery bypass graft or valve surgery and who received allogeneic RBCs. Three-hundred-twenty-one (74%) patients met the criteria for eligibility. After adjusting for the effects of confounders and the total number of RBC transfusions, the duration of storage of the oldest RBC unit transfused was found to be associated with both in-hospital mortality (Cox proportional hazard ratio (HR) = 1.151; P < 0.0001) and out-of-hospital mortality (HR = 1.116; P < 0.0001). The mean duration of storage of transfused RBCs was also an independent predictor of in-hospital mortality (HR = 1.036; P < 0.0001). Independent associations between the duration of storage of transfused RBCs and acute renal dysfunction and intensive care unit and hospital length of stay were also observed. The duration of storage of RBCs is associated with adverse outcome after repeat sternotomy for cardiac surgery. The clinical significance of this finding should be investigated in a large, randomized, blinded clinical trial.

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

“…12,17,20,23,24 More importantly in animal and human studies of patients in shock, microvascular perfusion and oxygen consumption remains the same or decreases with RBC transfusion. 8,17,[25][26][27]59 The importance of the effect of RBC storage age on outcomes in critically ill patients is highlighted by the fact that the average age of transfused RBCs in the United States is 22 days 60 and multiple studies have indicated that the age of RBCs transfused is associated with increased morbidity and mortality in the critically ill. 18,22,61 The independent association of the amount of RBC transfusions with decreased survival may be related to the increased storage age of RBCs transfused to all patients in our study (33 days). The mean storage age of RBCs transfused per patient was not able to be analyzed as a variable associated with survival since this data were not recorded per patient.…”

The use of cell saver system in cardiac surgery with cardiopulmonary bypass

“…The higher cost was observed in Group B, R$ 394.00 more. Several authors have also come to this conclusion [7][8][9]11] and, therefore, its indication has been made for specific cases in which bleeding is above normal [10]. However, we must take into consideration that the group using CS, 28 patients did not have UPRBC infusionn infusion, the total of 1.25 RBC / patient / hospitalization, and in Group A, 4.31.…”

“…Studies have shown that the use of homologous blood in cardiovascular surgery increases not only mortality but also morbidity [10][11][12] The use of cell saver machines began in the 1970s, due to an increasing demand by patients not to use blood. These requests were prompted by a religious group, which did not allow the use of stored blood to be infused into their worshipers.…”

Current issues relating to the transfusion of stored red blood cells

“…Because of the importance of the original Marik and Sibbold study in the debate over the quality of stored red blood Patients receiving older blood had longer ICU stay but did not have a higher need for ICU care [51] Randomized trial of RBC < 10 or > 10 days in surgical and critically ill patients This largest well-conducted retrospective review found no association [53] Review of registry of all repeat midline sternotomy patients for CABG, valve, or both 321 Age of RBCs, associated in a regression model with in-hospital and out-of-hospital mortality Age of red blood cells, associated in a regression model with in-hospital and out-of-hospital mortality cells, Walsh and his colleagues at the Edinburgh Royal Infirmary reported a randomized, prospective double blind trial in 2004 [48]. Twelve patient volunteers in septic shock were randomized to receive transfusions with red blood cells stored for greater than 20 days, and 10 more were given red blood cells stored for less than 5 days.…”

“…Multivariate analysis usually cannot deconstruct this kind of bias. [54] In 2006, van der Watering and his colleagues published a review of the experience of 2732 patients who underwent CABG in a single hospital between 1993 and 1999 and who had received transfusions of buffy-coat-reduced but not leucocytefiltred red blood cells [53]. They looked for an association between red blood cell length of storage measured as (i) mean storage time of all perioperative red blood cell transfusions; (ii) storage time of the youngest red blood cell transfusion; and (iii) storage time of the oldest red blood cell transfusion; and (iv) in patients receiving red blood cells with a storage time below the median storage of 18 days vs. patients receiving red blood cell with a storage time above the median and outcome measures of 30-day mortality, hospital length of stay, and ICU length of stay.…”