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Red-Cell Storage Duration and Outcomes | Journal Scan
Study Questions:
What are the clinical outcomes after cardiac surgery in patients who received transfused red cells stored for ≤10 days or for ≥21 days?
Methods:
The investigators conducted a randomized trial at multiple sites from 2010 to 2014. Participants ≥12 years of age who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for ≤10 days (shorter-term storage group) or for ≥21 days (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0-24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of death or discharge.
Results:
The median storage time of red-cell units provided to the 1,098 participants who received red-cell transfusion was 7 days in the shorter-term storage group and 28 days in the longer-term storage group. The mean change in MODS was an increase of 8.5 and 8.7 points, respectively (95% confidence interval for the difference, −0.6 to 0.3; p = 0.44). The 7-day mortality was 2.8% in the shorter-term storage group and 2.0% in the longer-term storage group (p = 0.43); 28-day mortality was 4.4% and 5.3%, respectively (p = 0.57). Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group.
Conclusions:
The authors concluded that the duration of red-cell storage was not associated with significant differences in the change in multiple organ dysfunction score.
Perspective:
This study reports that the duration of red-cell storage was not associated with significant differences in multiple organ dysfunction score. Furthermore, the transfusion of red cells stored for ≤10 days was not superior to the transfusion of red cells stored for ≥21 days. While several other trials such as the Age of Blood Evaluation trial and the Age of Blood in Children in Pediatric Intensive Care Units trial are investigating whether there may be other patient populations in which red-cell storage duration does have a clinical effect, available evidence does not support the preferential transfusion of red cells with shorter storage periods in patients undergoing complex cardiac surgery.
Keywords: Blood Transfusion, Cardiac Surgical Procedures, Erythrocyte Transfusion, Erythrocytes, Hyperbilirubinemia, Leukocytes, Multiple Organ Failure
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