by Lehr, Anab
Rebecca; Hébert, Paul; Fergusson, Dean; Sabri, Elham; Lacroix, Jacques
Critical Care Medicine: December 26, 2022.
Objectives: The Age of Blood Evaluation (ABLE)
study reported no clinical benefit in fresher compared with standard delivery
RBC units (length of storage: 6.9 ± 4.1 vs 22.0 ± 8.4 d, respectively). Perioperative
patients are often anemic, at risk of blood loss, and more exposed to RBC
transfusions. We address the question whether fresh RBC units are safer than
standard delivery RBC units in perioperative ICU patients.
Design: Subgroup analysis of surgical nontrauma
adults enrolled in the ABLE randomized controlled trial.
Setting: ICUs.
Patients: Three hundred twenty surgical patients
among the 2,510 ICU adults recruited in the ABLE study who had a request for a
first RBC transfusion in the first week in ICU stay and an
anticipated length of mechanical ventilation greater than or equal to 48 hours.
We included perioperative patients but excluded elective cardiac surgery and
trauma.
Interventions: Surgical participants were
allocated to receive either RBC units stored less than or equal to 7 days or
standard issue RBC.
MEASUREMENTS AND MAIN RESULTS:
The primary outcome was 90-day all-cause mortality.
One hundred seventy-two perioperative patients were
allocated to the fresh and 148 to the standard group. Baseline data were
similar. The length of storage was 7.2 ± 6.4 in fresh and 20.6 ± 8.4 days in
standard group (p < 0.0001). The 90-day mortality was 29.7% and 28.4%,
respectively (absolute risk difference: 0.01; 95% CI –0.09 to 0.11; p =
0.803). No significant differences were observed for all secondary outcomes,
including 6-month mortality, even after adjustment for age, country, and Acute
Physiology and Chronic Health Evaluation score.
Conclusions: There was no evidence that fresh
red cells improved outcomes as compared to standard issue red cells in
critically ill surgical patients, consistent with other patients enrolled in
the ABLE trial.
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