N Engl J Med

Liberal blood transfusion may benefit critically ill patients with TBI

June 17, 2024

Among critically ill patients with traumatic brain injury and anemia, a liberal transfusion strategy didn't reduce the risk of an unfavorable neurologic outcome at six months. Some, but not all, functional independence and quality-of-life scales favored a liberal strategy however.

• 742 adults with moderate or severe traumatic brain injury and anemia were randomly assigned to receive red cell transfusion according to a liberal strategy (n=371; median Hgb level, 10.8 g/dL) or a restrictive strategy (n=371; median Hgb level, 8.8 g/dL). Primary outcome was an unfavorable outcome as assessed by the score on the Glasgow Outcome Scale-Extended at six months; secondary outcomes included mortality, functional independence, quality of life, and depression at 6 months.
• An unfavorable outcome occurred in 68.4% in the liberal-strategy group and in 73.5% in the restrictive-strategy group (adjusted absolute difference, 5.4 percentage points; 95% confidence interval, -2.9 to 13.7). Among survivors, a liberal strategy was associated with higher scores on some but not all the scales assessing functional independence and quality of life.
• No association was observed between transfusion strategy and mortality or depression. VTE events occurred in 8.4% of patients in each group, and acute respiratory distress syndrome occurred in 3.3% and 0.8% of patients in the liberal-strategy and restrictive-strategy groups, respectively.

Source:

Turgeon AF; HEMOTION Trial Investigators on behalf of the Canadian Critical Care Trials Group, the Canadian Perioperative Anesthesia Clinical Trials Group, and the Canadian Traumatic Brain Injury Research Consortium. (2024, June 13). N Engl J Med. Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury. https://pubmed.ncbi.nlm.nih.gov/38869931/