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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 6/2019

01-06-2019 | Central Nervous System Trauma | Reports of Original Investigations

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

Authors: Jessica Ruel-Laliberté, MD, MSc, Paule Lessard Bonaventure, MD, MSc, Dean Fergusson, PhD, Jacques Lacroix, MD, Ryan Zarychanski, MD, MSc, François Lauzier, MD, MSc, Alan Tinmouth, MD, MSc, Paul C. Hébert, MD, MSc, Robert Green, MD, Donald Griesdale, MD, MSc, Robert Fowler, MD, MSc, Andreas Kramer, MD, Lauralyn A. McIntyre, MD, MSc, David Zygun, MD, MSc, Tim Walsh, MSc, PhD, Simon Stanworth, MD, PhD, Gilles Capellier, MD, Sébastien Pili-floury, MD, PhD, Emmanuel Samain, MD, Lucy Clayton, MSc, John Marshall, MD, Giuseppe Pagliarello, MD, Elham Sabri, MSc, Xavier Neveu, MSc, Caroline Léger, PhD, Alexis F. Turgeon, MD, MSc, the Canadian Critical Care Trials Group

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 6/2019

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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.
Appendix
Available only for authorised users
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Metadata
Title
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
Authors
Jessica Ruel-Laliberté, MD, MSc
Paule Lessard Bonaventure, MD, MSc
Dean Fergusson, PhD
Jacques Lacroix, MD
Ryan Zarychanski, MD, MSc
François Lauzier, MD, MSc
Alan Tinmouth, MD, MSc
Paul C. Hébert, MD, MSc
Robert Green, MD
Donald Griesdale, MD, MSc
Robert Fowler, MD, MSc
Andreas Kramer, MD
Lauralyn A. McIntyre, MD, MSc
David Zygun, MD, MSc
Tim Walsh, MSc, PhD
Simon Stanworth, MD, PhD
Gilles Capellier, MD
Sébastien Pili-floury, MD, PhD
Emmanuel Samain, MD
Lucy Clayton, MSc
John Marshall, MD
Giuseppe Pagliarello, MD
Elham Sabri, MSc
Xavier Neveu, MSc
Caroline Léger, PhD
Alexis F. Turgeon, MD, MSc
the Canadian Critical Care Trials Group
Publication date
01-06-2019
Publisher
Springer International Publishing
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 6/2019
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-019-01326-7

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