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Individualised or liberal red blood cell transfusion after cardiac surgery: a randomised controlled trial

Normandy University, UNICAEN, CHU de Caen Normandie, Service d'Anesthésie Réanimation, Caen, France. Electronic address: fischer-mo@chu-caen.fr. Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital, Dijon, France. Normandy University, UNICAEN, CHU de Caen Normandie, Service d'Anesthésie Réanimation, Caen, France. Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, Amiens, France. Normandy University, UNICAEN, CHU de Caen Normandie, Department of Cardiac Surgery, Caen, France. Department of Cardiac Surgery, Amiens University Hospital, Amiens Picardy University Hospital, Amiens, France. Department of Anesthesiology and Critical Care Medicine, Clinique du Millénaire, Montpellier, France. Department of Biostatistics, Amiens Picardy University Hospital, Amiens, France.

British journal of anaesthesia. 2021
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PICO Summary

Population

Patients admitted to intensive care unit after cardiac surgery (n= 164).

Intervention

Transfusion with one unit of red blood cells (RBCs), (haemoglobin group), (n= 82).

Comparison

Transfusion only if the ScvO(2) was <70% (individualised group), (n= 82).

Outcome

The number of patients receiving at least one unit of RBCs was observed for 80 of 80 subjects (100%) in the haemoglobin group and in 61 of 77 patients (79%) in the individualised group. There was no significant difference in the secondary outcome between the two groups. Follow-up showed a non-significant difference in mortality at 1 and 6 months.
Abstract
BACKGROUND Current practice guidelines for red blood cell (RBC) transfusion in ICUs are based on haemoglobin threshold, without consideration of oxygen delivery or consumption. We aimed to evaluate an individual physiological threshold-guided by central venous oxygen saturation ScvO(2). METHODS In a randomised study in two French academic hospitals, 164 patients who were admitted to ICU after cardiac surgery with postoperative haemoglobin <9 g dl(-1) were randomised to receive a transfusion with one unit of RBCs (haemoglobin group) or transfusion only if the ScvO(2) was <70% (individualised group). The primary outcome was the number of subjects receiving at least one unit of RBCs. The secondary composite outcome was acute kidney injury, stroke, myocardial infarction, acute heart failure, mesenteric ischaemia, or in-hospital mortality. One- and 6-month mortality were evaluated during follow-up. RESULTS The primary outcome was observed for 80 of 80 subjects (100%) in the haemoglobin group and in 61 of 77 patients (79%) in the individualised group (absolute risk -21% [-32.0; -14.0]; P<0.001). There was no significant difference in the secondary outcome between the two groups. Follow-up showed a non-significant difference in mortality at 1 and 6 months. CONCLUSIONS An individualised strategy based on an central venous oxygen saturation threshold of 70% allows for a more restrictive red blood cell transfusion strategy with no incidence on postoperative morbidity or 6-month mortality. CLINICAL TRIAL REGISTRATION NCT02963883.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine