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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

Ruel-Laliberte, Jessica. CHU de Quebec - Universite Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Universite Laval, Quebec City, QC, Canada. Lessard Bonaventure, Paule. CHU de Quebec - Universite Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Universite Laval, Quebec City, QC, Canada. Fergusson, Dean. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Lacroix, Jacques. CHU Ste-Justine Research Centre, CHU Ste-Justine, Universite de Montreal, Montreal, QC, Canada. Zarychanski, Ryan. Department of Internal Medicine, Sections of Critical Care Medicine, of Haematology and of Medical Oncology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada. Lauzier, Francois. CHU de Quebec - Universite Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Universite Laval, Quebec City, QC, Canada. Lauzier, Francois. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Universite Laval, Quebec City, QC, Canada. Lauzier, Francois. Department of Medicine, Faculty of Medicine, Universite Laval, Quebec City, QC, Canada. Tinmouth, Alan. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Hebert, Paul C. Department of Medicine, Centre Hospitalier Universitaire de Montreal, Universite de Montreal, Montreal, QC, Canada. Green, Robert. Department of Emergency Medicine, Division of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada. Griesdale, Donald. Department of Anesthesiology, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada. Fowler, Robert. Department of Critical Care Medicine, Sunnybrook Health Services Centre, University of Toronto, Toronto, ON, Canada. Kramer, Andreas. Department of Critical Care Medicine, Foothills Health Sciences Centre, University of Calgary, Calgary, AB, Canada. McIntyre, Lauralyn A. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. McIntyre, Lauralyn A. Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Ontario, ON, Canada. Zygun, David. Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada. Walsh, Tim. University of Edinburgh, Edinburgh, UK. Stanworth, Simon. Department of Hematology, University of Oxford, Oxford, UK. Capellier, Gilles. Department of Anesthesiology and Critical Care Medicine, Universite de Besancon, Besancon, France. Pili-Floury, Sebastien. Department of Anesthesiology and Critical Care Medicine, Universite de Besancon, Besancon, France. Samain, Emmanuel. Department of Anesthesiology and Critical Care Medicine, Universite de Besancon, Besancon, France. Clayton, Lucy. CHU Ste-Justine Research Centre, CHU Ste-Justine, Universite de Montreal, Montreal, QC, Canada. Marshall, John. Department of Medicine, Centre Hospitalier Universitaire de Montreal, Universite de Montreal, Montreal, QC, Canada. Pagliarello, Giuseppe. Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Ontario, ON, Canada. Sabri, Elham. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Neveu, Xavier. CHU de Quebec - Universite Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Universite Laval, Quebec City, QC, Canada. Leger, Caroline. CHU de Quebec - Universite Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Universite Laval, Quebec City, QC, Canada. Turgeon, Alexis F. CHU de Quebec - Universite Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Universite Laval, Quebec City, QC, Canada. alexis.turgeon@fmed.ulaval.ca. Turgeon, Alexis F. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Universite Laval, Quebec City, QC, Canada. alexis.turgeon@fmed.ulaval.ca. Turgeon, Alexis F. Centre de recherche du CHU de Quebec - Universite Laval, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Hopital de l'Enfant-Jesus, 1401, 18e Rue, Room Z-204, Quebec City, QC, G1J 1Z4, Canada. alexis.turgeon@fmed.ulaval.ca.

Canadian Journal of Anaesthesia. 2019;66(6):696-705
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Abstract
BACKGROUND Anemia is common in critically ill patients with traumatic brain injury, and often requires red blood cell transfusion. Studies suggest that prolonged storage causes lesions of the red blood cells, including a decreased ability to carry oxygen. Considering the susceptibility of the brain to hypoxemia, victims of traumatic brain injury may thus be more vulnerable to exposure to older red blood cells. METHODS Our study aimed to ascertain whether the administration of fresh red blood cells (seven days or less) results in a better neurologic outcome compared with standard red blood cells in critically ill patients with traumatic brain injury requiring transfusion. The Age of Blood Evaluation in traumatic brain injury (ABLE-tbi) study was a nested study within the ABLE study (ISRCTN44878718). Our primary outcome was the extended Glasgow Outcome Scale (GOSe) at six months. RESULTS In the ABLE study, 217 subjects suffered a traumatic brain injury: 110 in the fresh group, and 107 in the standard group. In the fresh group, 68 (73.1%) of the patients had an unfavourable neurologic outcome (GOSe <= 4) compared with 60 (64.5%) in the standard group (P = 0.21). Using a sliding dichotomy approach, we observed no overall effect of fresh red blood cells on neurologic outcome (odds ratio [OR], 1.34; 95% confidence interval [CI], 0.72 to 2.50; P = 0.35) but observed differences across prognostic bands with a decreased odds of unfavourable outcome in patients with the best prognosis at baseline (OR, 0.33; 95% CI, 0.11 to 0.96; P = 0.04) but an increased odds in those with intermediate and worst baseline prognosis (OR, 5.88; 95% CI,1.66 to 20.81; P = 0.006; and OR, 1.67; 95% CI, 0.53 to 5.30; P = 0.38, respectively). CONCLUSION Overall, transfusion of fresh red blood cells was not associated with a better neurologic outcome at six months in critically ill patients with traumatic brain injury. Nevertheless, we cannot exclude a differential effect according to the patient baseline prognosis. TRIAL REGISTRATION ABLE study (ISRCTN44878718); registered 22 August, 2008.
Study details
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine