Effect of age of transfused red blood cells on neurological outcome in critically ill patients with traumatic brain injury (ABLE-tbi Study)
CCCF ePoster library. Ruel-Laliberté J. Oct 3, 2017; 198177; 54
Dr. Jessica Ruel-Laliberté
Dr. Jessica Ruel-Laliberté
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Abstract
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Effect of age of transfused red blood cells on neurological outcome in critically ill patients with traumatic brain injury (ABLE-tbi Study)

Ruel-laliberté, Jessica 1 ; Fergusson, Dean 2 ; Lacroix, Jacques 3 ; Zarychanski, Ryan 4 ; Lauzier, François 1,5 ; Lessard Bonaventure, Paule 1 ; Tinmouth, Alan 2 ; Green, Robert 6 ; Griesdale, Donald 7 ; Fowler, Robert 8 ; Kramer, Andreas 9 ; McIntyre, Lauralyn 2; Zygun, David 10; Walsh, Tim 11; Stanworth, Simon 12; Léger, Caroline 1;  F. Turgeon, Alexis 1,5 



1. CHU de Québec – Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec City, Québec, Canada.

2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada

3. CHU Ste-Justine Research Centre, CHU Ste-Justine, Université de Montréal, Montréal, Canada.

4. Department of Internal Medicine, Sections of Critical Care Medicine, of Haematology and of Medical Oncology, University of Manitoba, Winnipeg, Canada.

5. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada.

6. Department of Emergency Medicine, Division of Critical Care Medicine, Dalhousie University, Halifax, Canada

7. Department of Anesthesiology, Division of Critical Care Medicine, University of British Columbia, Vancouver, Canada

8. Department of Critical Care Medicine, Sunnybrook Health Services Centre, University of Toronto, Toronto, Canada

9. Department of Critical Care Medicine, Foothills Health Sciences Centre, University of Calgary, Calgary, Canada

10. Department of Critical Care Medicine, University of Alberta, Edmonton, Canada

11. Department of Critical Care Medicine, University of Edinburgh, Edinburgh, United Kingdom

12. Department of Hematology, University of Oxford, Oxford, United Kingdom


Introduction
Anemia is frequent in critically ill patients with traumatic brain (TBI), often leading to RBC transfusions. RBC can be stored up to 42 days, but it was suggested that prolonged storage may cause a decreased ability to carry oxygen. Considering the susceptibility of the brain to hypoxemia, the age of RBC transfused to TBI patients may have a potential impact on outcomes.

Methods
We conducted an a priori planned analysis of the TBI patients enrolled (n=217) in the ABLE study, a large multicenter RCT comparing the use of fresh blood (less than 8 days) to the use of standard issued blood in critically ill patients on mechanical ventilation (ISRCTN44878718)1. Our primary outcome measure was the Glasgow Outcome Scale extended (GOSe) at 6-month; secondary outcomes were ICU, hospital and 6-month mortality.

Results
Groups were comparable for the main patient characteristics (n=110 for the fresh group and n=107 for the standard group). RBC were stored for 5+/-3 days in the fresh group and 18+/-6 days in the standard group (p<0.0001). GOSe was available in 93 patients in each group. 26.9% of the patients in the fresh group had a favorable neurological outcome at 6 months (GOSe score of 5 to 8) as compared to 35.5% in the standard group (p=0.21). Sliding dichotomy analysis with the GOSe showed no significant difference in outcome for the overall GOSe (Fig. 1). No effect on ICU, in-hospital or 6 months mortality was observed.

Conclusion
Our results suggest that transfusing fresh RBC is not associated with improved 6-months neurological outcome in critically ill patients with TBI.
 

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