Departments of Anesthesiology and Perioperative Medicine and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Anesthesiology. 2023 Aug 1;139(2):153-163. doi: 10.1097/ALN.0000000000004605.
BACKGROUND: Delayed cold storage of room temperature platelets may extend shelf life from 5 to 14 days. The study hypothesized that the use of delayed cold-stored platelets in cardiac surgery would be associated with decreased postoperative platelet count increments but similar transfusion and clinical outcomes compared to room temperature-stored platelets. METHODS: This is an observational cohort study of adults transfused with platelets intraoperatively during elective cardiac surgery between April 2020 and May 2021. Intraoperative platelets were either room temperature-stored or delayed cold-stored based on blood bank availability rather than clinical features or provider preference. Differences in transfusion and clinical outcomes, including a primary outcome of allogenic transfusion exposure in the first 24 h postoperatively, were compared between groups. RESULTS: A total of 713 patient encounters were included: 529 (74%) room temperature-stored platelets and 184 (26%) delayed cold-stored platelets. Median (interquartile range) intraoperative platelet volumes were 1 (1 to 2) units in both groups. Patients receiving delayed cold-stored platelets had higher odds of allogeneic transfusion in the first 24 h postoperatively (81 of 184 [44%] vs. 169 of 529 [32%]; adjusted odds ratio, 1.65; 95% CI, 1.13 to 2.39; P = 0.009), including both erythrocytes (65 of 184 [35%] vs. 135 of 529 [26%]; adjusted odds ratio, 1.54; 95% CI, 1.03 to 2.29; P = 0.035) and platelets (48 of 184 [26%] vs. 79 of 529 [15%]; adjusted odds ratio, 1.91; 95% CI, 1.22 to 2.99; P = 0.005). There was no difference in the number of units administered postoperatively among those transfused. Platelet counts were modestly lower in the delayed cold-stored platelet group (-9 × 109/l; 95% CI, -16 to -3]) through the first 3 days postoperatively. There were no significant differences in reoperation for bleeding, postoperative chest tube output, or clinical outcomes. CONCLUSIONS: In adults undergoing cardiac surgery, delayed cold-stored platelets were associated with higher postoperative transfusion utilization and lower platelet counts compared to room temperature-stored platelets without differences in clinical outcomes. The use of delayed cold-stored platelets in this setting may offer a viable alternative when facing critical platelet inventories but is not recommended as a primary transfusion approach.
背景：室温保存的血小板可将保存期从 5 天延长至 14 天。本研究假设，与室温保存的血小板相比，心脏手术中使用延迟冷储的血小板与术后血小板计数增加减少相关，但输血和临床结局相似。
方法：这是一项观察性队列研究，纳入了 2020 年 4 月至 2021 年 5 月期间择期心脏手术期间术中输注血小板的成年人。术中血小板根据血库的可用性，而不是临床特征或提供者偏好，分为室温保存或延迟冷储。比较两组间输血和临床结局的差异，包括术后 24 小时内异体输血暴露的主要结局。
结果：共纳入 713 例患者：529 例（74%）为室温保存血小板，184 例（26%）为延迟冷储血小板。两组术中血小板体积中位数（四分位距）均为 1（1 至 2）单位。输注延迟冷储血小板的患者术后 24 小时内异体输血的可能性更高（81/184 [44%] 比 169/529 [32%]；调整后的优势比，1.65；95%CI，1.13 至 2.39；P=0.009），包括红细胞（65/184 [35%] 比 135/529 [26%]；调整后的优势比，1.54；95%CI，1.03 至 2.29；P=0.035）和血小板（48/184 [26%] 比 79/529 [15%]；调整后的优势比，1.91；95%CI，1.22 至 2.99；P=0.005）。术后输注的单位数无差异。与室温保存血小板相比，延迟冷储血小板组术后前 3 天血小板计数平均减少 9×109/L（95%CI，-16 至-3]）。两组再手术出血、术后胸腔引流量或临床结局无显著差异。
结论：在接受心脏手术的成年人中，与室温保存的血小板相比，延迟冷储的血小板与术后更高的输血使用率和更低的血小板计数相关，但临床结局无差异。在面临血小板库存临界时，该方法可能是一种可行的替代方案，但不建议作为主要的输血方法。
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