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Effect of red blood cell storage duration on major postoperative complications in cardiac surgery: A randomized trial
| Content Provider | Scilit |
|---|---|
| Author | Koch, Colleen G. Sessler, Daniel I. Duncan, Andra E. Mascha, Edward J. Li, Liang Yang, Dongsheng Figueroa, Priscilla Sabik, Joseph F. Mihaljevic, Tomislav Svensson, Lars G. Blackstone, Eugene H. |
| Copyright Year | 2019 |
| Description | Journal: Journal of Thoracic and Cardiovascular Surgery Background Although observational studies suggest an association between transfusion of older red blood cell (RBC) units and increased postoperative risk, randomized trials have not supported this. The objective of this randomized trial was to test the effect of RBC storage age on outcomes after cardiac surgery. Methods From July 2007 to May 2016, 3835 adults undergoing coronary artery bypass grafting, cardiac valve procedures, or ascending aorta repair, either alone or in combination, were randomized to transfusion of RBCs stored for ≤14 days (younger units) or for ≥20 days (older units) intraoperatively and throughout the postoperative hospitalization. According to protocol, 2448 patients were excluded because they did not receive RBC transfusions. Among the remaining 1387 modified intent-to-treat patients, 701 were randomized to receive younger RBC units (median age, 11 days) and the remaining 686 to receive older units (median age, 25 days). The primary endpoint was composite morbidity and mortality, analyzed using a generalized estimating equation (GEE) model. The trial was discontinued midway owing to enrollment constraints. Results A total of 5470 RBC units were transfused, including 2783 in the younger RBC storage group and 2687 in the older RBC storage group. The GEE average relative-effect odds ratio was 0.77 (95% confidence interval [CI], 0.50-1.19; P = .083) for the composite morbidity and mortality endpoint. In-hospital mortality was lower for the younger RBC storage group (2.1% [n = 15] vs 3.4% [n = 23]), as was occurrence of other adverse events except for atrial fibrillation, although all CIs crossed 1.0. Conclusions This clinical trial, which was stopped at its midpoint owing to enrollment constraints, supports neither the efficacy nor the futility of transfusing either younger or older RBC units. The effects of transfusing RBCs after even more prolonged storage (35-42 days) remains untested. |
| Related Links | http://www.jtcvs.org/article/S0022522319322226/pdf |
| ISSN | 00225223 |
| e-ISSN | 1097685X |
| DOI | 10.1016/j.jtcvs.2019.09.165 |
| Journal | Journal of Thoracic and Cardiovascular Surgery |
| Issue Number | 6 |
| Volume Number | 160 |
| Language | English |
| Publisher | Elsevier BV |
| Publisher Date | 2019-10-16 |
| Access Restriction | Open |
| Subject Keyword | Journal: Journal of Thoracic and Cardiovascular Surgery Postoperative Outcomes Distinct-effects Generalized Estimating Equation Model Confidence Interval Generalized Estimating Equation Intensive Care Unit Multiple Organ Dysfunction Syndrome Society of Thoracic Surgeons |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pulmonary and Respiratory Medicine Surgery Cardiology and Cardiovascular Medicine |
