Effet de l’âge des culots sanguins transfusés sur le devenir neurologique après un traumatisme cérébral (étude ABLE-tbi) : une étude imbriquée dans l’essai clinique ABLE (Age of Blood Evaluation)

the Canadian Critical Care Trials Group

doi:10.1007/s12630-019-01326-7

Effet de l’âge des culots sanguins transfusés sur le devenir neurologique après un traumatisme cérébral (étude ABLE-tbi) : une étude imbriquée dans l’essai clinique ABLE (Age of Blood Evaluation)

Translated title of the contribution: 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

the Canadian Critical Care Trials Group

Medicine

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

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.

Translated title of the contribution	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
Original language	French
Pages (from-to)	696-705
Number of pages	10
Journal	Canadian Journal of Anaesthesia
Volume	66
Issue number	6
DOIs	https://doi.org/10.1007/s12630-019-01326-7
Publication status	Published - Jun 15 2019

Bibliographical note

Funding Information:
Funding Dr. Turgeon is the chairholder of the Canada Research Chair in Critical Neurology and Trauma. Drs. Lauzier and Moore are recipients of a research career award from the Fonds de Recherche du Québec - Santé (FRQS). Dr. Hébert holds the Héma-Québec - Bayer Endowed Chair in Transfusion Medicine from Université de Montréal. Drs. Turgeon, Lauzier, and Moore are supported by the Traumatology Research Consortium of the FRQS. Dr. Zarychanski and Turgeon were recipients of a New Investigator Award from the Canadian Institutes of Health Research (CIHR) when this work was conducted.

Funding Information:
We want to thank the Grants and Manuscript Committee of the Canadian Critical Care Trials Group for the internal review process prior to submission. None declared. This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia. Jessica Ruel-Lalibert?, Dean Fergusson, Jacques Lacroix, Ryan Zarychanski, Fran?ois Lauzier, Alan Tinmouth, and Alexis F. Turgeon were involved in study concept and design. Jessica Ruel-Lalibert?, Dean Fergusson, Jacques Lacroix, Ryan Zarychanski, Alan Tinmouth, Paul C. H?bert, Robert Green, Donald Griesdale, Robert Fowler, Andreas Kramer, Lauralyn A. McIntyre, David Zygun, Tim Walsh, Simon Stanworth, Gilles Capellier, S?bastien Pili-floury, Emmanuel Samain, Lucy Clayton, John Marshall, Giuseppe Pagliarello , and Alexis F. Turgeon were involved in acquisition of the data. Jessica Ruel-Lalibert?, Paule Lessard Bonaventure, Dean Fergusson, Jacques Lacroix, Ryan Zarychanski, Alan Tinmouthi, Paul C. H?bert, Robert Green, Donald Griesdale, Robert Fowler, Andreas Kramer, Lauralyn A. McIntyre, David Zygun, Tim Walsh , Simon Stanworth, Gilles Capellier, S?bastien Pili-floury, Emmanuel Samain, Lucy Clayton, John Marshall, Giuseppe Pagliarello, Caroline L?ger , and Alexis F. Turgeon were involved in the interpretation of data. Jessica Ruel-Lalibert?, Caroline L?ger , and Alexis F. Turgeon were involved in drafting the manuscript. Elham Sabri, Xavier Neveu , and Alexis F. Turgeon were involved in the statistical analyses. All authors were involved in critical revision of the manuscript. Alexis F. Turgeon supervised the study. Dr. Turgeon is the chairholder of the Canada Research Chair in Critical Neurology and Trauma. Drs. Lauzier and Moore are recipients of a research career award from the Fonds de Recherche du Qu?bec - Sant? (FRQS). Dr. H?bert holds the H?ma-Qu?bec - Bayer Endowed Chair in Transfusion Medicine from Universit? de Montr?al. Drs. Turgeon, Lauzier, and Moore are supported by the Traumatology Research Consortium of the FRQS. Dr. Zarychanski and Turgeon were recipients of a New Investigator Award from the Canadian Institutes of Health Research (CIHR) when this work was conducted.

Publisher Copyright:
© 2019, Canadian Anesthesiologists' Society.

ASJC Scopus Subject Areas

Anesthesiology and Pain Medicine

PubMed: MeSH publication types

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Access to Document

10.1007/s12630-019-01326-7

Cite this

Effet de l’âge des culots sanguins transfusés sur le devenir neurologique après un traumatisme cérébral (étude ABLE-tbi) : une étude imbriquée dans l’essai clinique ABLE (Age of Blood Evaluation). / the Canadian Critical Care Trials Group.
In: Canadian Journal of Anaesthesia, Vol. 66, No. 6, 15.06.2019, p. 696-705.

Research output: Contribution to journal › Article › peer-review

@article{09cb290af38a4fbb887b3950e7b83f53,

title = "Effet de l{\textquoteright}{\^a}ge des culots sanguins transfus{\'e}s sur le devenir neurologique apr{\`e}s un traumatisme c{\'e}r{\'e}bral ({\'e}tude ABLE-tbi) : une {\'e}tude imbriqu{\'e}e dans l{\textquoteright}essai clinique ABLE (Age of Blood Evaluation)",

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.",

author = "{the Canadian Critical Care Trials Group} and Jessica Ruel-Lalibert{\'e} and {Lessard Bonaventure}, Paule and Dean Fergusson and Jacques Lacroix and Ryan Zarychanski and Fran{\c c}ois Lauzier and Alan Tinmouth and H{\'e}bert, {Paul C.} and Robert Green and Donald Griesdale and Robert Fowler and Andreas Kramer and McIntyre, {Lauralyn A.} and David Zygun and Tim Walsh and Simon Stanworth and Gilles Capellier and S{\'e}bastien Pili-floury and Emmanuel Samain and Lucy Clayton and John Marshall and Giuseppe Pagliarello and Elham Sabri and Xavier Neveu and Caroline L{\'e}ger and Turgeon, {Alexis F.}",

note = "Publisher Copyright: {\textcopyright} 2019, Canadian Anesthesiologists' Society.",

year = "2019",

month = jun,

day = "15",

doi = "10.1007/s12630-019-01326-7",

language = "Fran{\c c}ais",

volume = "66",

pages = "696--705",

journal = "Canadian Journal of Anaesthesia",

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TY - JOUR

T1 - Effet de l’âge des culots sanguins transfusés sur le devenir neurologique après un traumatisme cérébral (étude ABLE-tbi)

T2 - une étude imbriquée dans l’essai clinique ABLE (Age of Blood Evaluation)

AU - the Canadian Critical Care Trials Group

AU - Ruel-Laliberté, Jessica

AU - Lessard Bonaventure, Paule

AU - Fergusson, Dean

AU - Lacroix, Jacques

AU - Zarychanski, Ryan

AU - Lauzier, François

AU - Tinmouth, Alan

AU - Hébert, Paul C.

AU - Green, Robert

AU - Griesdale, Donald

AU - Fowler, Robert

AU - Kramer, Andreas

AU - McIntyre, Lauralyn A.

AU - Zygun, David

AU - Walsh, Tim

AU - Stanworth, Simon

AU - Capellier, Gilles

AU - Pili-floury, Sébastien

AU - Samain, Emmanuel

AU - Clayton, Lucy

AU - Marshall, John

AU - Pagliarello, Giuseppe

AU - Sabri, Elham

AU - Neveu, Xavier

AU - Léger, Caroline

AU - Turgeon, Alexis F.

PY - 2019/6/15

Y1 - 2019/6/15

N2 - 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.

AB - 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.

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