Green Robert S, Erdogan Mete, Lacroix Jacques, Hébert Paul C, Tinmouth Alan T, Sabri Elham, Zhang Tinghua, Fergusson Dean A, Turgeon Alexis F
Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada.
Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada.
Transfusion. 2018 Aug;58(8):1846-1854. doi: 10.1111/trf.14640. Epub 2018 Apr 19.
Blood transfusion is common in the resuscitation of patients with traumatic injury. However, the clinical impact of the length of storage of transfused blood is unclear in this population.
We undertook a prespecified nested analysis of 372 trauma victims of the 2510 critically ill patients from 64 centers treated as part of the Age of Blood Evaluation (ABLE) randomized controlled trial. Patients were randomized according to their trauma status to receive either a transfusion of fresh blood stored not more than 7 days or standard-issue blood. Our primary outcome was 90-day all-cause mortality.
Overall, 186 trauma patients received fresh blood and 186 received standard-issue blood. Adherence to transfusion protocol was 94% (915/971) for all fresh blood transfused and 100% (753/753) for all standard-issue blood transfused. Mean ± SD blood storage duration was 5.6 ± 3.8 days in the fresh group and 22.7 ± 8.4 days in the standard-issue group (p < 0.001). Ninety-day mortality in the fresh group was 21% (38/185), compared to 16% (29/184) in the standard-issue group, with an unadjusted absolute risk difference of 5% (95% confidence interval [CI], -3.1 to 12.6) and an adjusted absolute risk difference of 2% (95% CI, -3.5 to 6.8).
In critically ill trauma patients, transfusion of fresh blood did not decrease 90-day mortality or secondary outcomes, a finding similar to the overall population of the ABLE trial.
输血在创伤患者的复苏中很常见。然而，在这一人群中，输血储存时间长短的临床影响尚不清楚。
我们对作为血液评估时代（ABLE）随机对照试验一部分接受治疗的64个中心的2510例重症患者中的372例创伤受害者进行了预先指定的巢式分析。患者根据其创伤状态随机接受不超过7天储存的新鲜血液输血或标准血液输血。我们的主要结局是90天全因死亡率。
总体而言，186例创伤患者接受了新鲜血液，186例接受了标准血液。所有输注的新鲜血液的输血方案依从率为94%（915/971），所有输注的标准血液的输血方案依从率为100%（753/753）。新鲜组的平均±标准差血液储存时间为5.6±3.8天，标准组为22.7±8.4天（p<0.001）。新鲜组的90天死亡率为21%（38/185），标准组为16%（29/184），未调整的绝对风险差异为5%（95%置信区间[CI]，-3.1至12.6），调整后的绝对风险差异为2%（95%CI，-3.5至6.8）。
在重症创伤患者中，输注新鲜血液并未降低90天死亡率或次要结局，这一发现与ABLE试验的总体人群相似。
