Restrictive Transfusion Strategy Is More Effective in Massive Burns: Results of the TRIBE Multicenter Prospective Randomized Trial

University of California Davis and Shriners Hospital for Children Northern California, 2425 Stockton Boulevard, Suite 718, Sacramento, CA. Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd Winston-Salem, NC. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX. The Arizona Burn Center, The Arizona Burn Center and University of Arizona College of Medicine, 2601 E Roosevelt St, Phoenix, AZ. University of Utah Department of Surgery, 50N Medical Dr, Salt Lake City, UT. Institute of Surgical Research, 3851 Roger Brooke Dr, Dept 2 Bld, San Antonio, TX. Community Regional Medical Center, 2823 Fresno St, Fresno, CA. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue D Wing, Room 712, Toronto, ON. Kansas University Medical Center, 3901 Rainbow Blvd, Kansas City, KS. University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre - 8440 - 112 Street University of Alberta, Edmonton, Alberta, Canada. New Zealand National Burn Centre, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand. University of Florida Health Science Center, 1600 SW Archer Rd, Room 7209 Gainesville, FL. JM Still Burn Center, 3651 Wheeler Rd, Augusta, GA. University of California Davis and Shriners Hospital for Children Northern California, 2425 Stockton Boulevard, Suite 718, Sacramento, CA. Department of Public Health Sciences, University of California Davis, Medical Sciences 1C, Room 104 University of California, Davis One Shields Avenue, Davis, CA. Department of Public Health Sciences, University of California Davis, Medical Sciences 1C, Room 104 University of California, Davis One Shields Avenue, Davis, CA.

Military Medicine. 2018
Abstract
Objectives: Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: compare outcomes between massive burn (≥60% total body surface area (TBSA) burn) and major (20-59% TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods: Patients with burns ≥20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin <7 g/dL) or liberal (transfuse hemoglobin <10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results: Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 +/- 47.63 vs. 77.16 +/- 55.0, p < 0.03 massive; 11.0 +/- 16.70 vs. 16.78 +/- 17.39, p < 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p < 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20-59%) group (p > 0.05). Conclusions: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.
Study details
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine