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The Effects of Storage Age of Blood in Massively Transfused Burn Patients

A Secondary Analysis of the Randomized Transfusion Requirement in Burn Care Evaluation Study

Cartotto, Robert, MD, FRCS(C)1; Taylor, Sandra L., PhD2; Holmes, James H. IV, MD3; Peck, Michael, MD4; Cochran, Amalia, MD, MA5; King, Booker T., Col, MD6; Bhavsar, Daval, MD7; Tredget, Edward E., MD, FRCS(C)8; Mozingo, David, MD9; Greenhalgh, David, MD, FACS10; Pollock, Brad H., PhD, MPH2; Palmieri, Tina L., MD, FACS10

doi: 10.1097/CCM.0000000000003383
Online Clinical Investigations

Objectives: Major trials examining storage age of blood transfused to critically ill patients administered relatively few blood transfusions. We sought to determine if the storage age of blood affects outcomes when very large amounts of blood are transfused.

Design: A secondary analysis of the multicenter randomized Transfusion Requirement in Burn Care Evaluation study which compared restrictive and liberal transfusion strategies.

Setting: Eighteen tertiary-care burn centers.

Patients: Transfusion Requirement in Burn Care Evaluation evaluated 345 adults with burns greater than or equal to 20% of the body surface area. We included only the 303 patients that received blood transfusions.

Interventions: The storage ages of all transfused red cell units were collected during Transfusion Requirement in Burn Care Evaluation. A priori measures of storage age were the the mean storage age of all transfused blood and the proportion of all transfused blood considered very old (stored ≥ 35 d).

Measurements and Main Results: The primary outcome was the severity of multiple organ dysfunction. Secondary outcomes included time to wound healing, the duration of mechanical ventilation, and in-hospital mortality. There were 6,786 red cell transfusions with a mean (± SD) storage age of 25.6 ± 10.2 days. Participants received a mean of 23.4 ± 31.2 blood transfusions (range, 1–219) and a mean of 5.3 ± 10.7 units of very old blood. Neither mean storage age nor proportion of very old blood had any influence on multiple organ dysfunction severity, time to wound healing, or mortality. Duration of ventilation was significantly predicted by both mean blood storage age and the proportion of very old blood, but this was of questionable clinical relevance given extreme variability in duration of ventilation (adjusted r2 ≤ 0.01).

Conclusions: Despite massive blood transfusion, including very old blood, the duration of red cell storage did not influence outcome in burn patients. Provision of the oldest blood first by Blood Banks is rational, even for massive transfusion.

1Department of Surgery, Ross Tilley Burn Centre, University of Toronto, ON, Canada.

2Department of Public Health Services, University of California, Davis, Sacramento, CA.

3Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC.

4Department of Surgery, The Arizona Burn Center, Phoenix, AZ.

5Department of Surgery, University of Utah, Salt Lake City, UT.

6Department of Surgery, Institute of Surgical Research, San Antonio, TX.

7Department of Surgery, Kansas University Medical Center, Kansas City, KS.

8Department of Surgery, University of Alberta, Edmonton, AB, Canada.

9Department of Surgery, University of Florida Health Sciences Center, Gainsville, FL.

10Department of Surgery, University of California, Davis and Shriners Hospital for Children Northern California, Sacramento, CA.

Trial Registration: NCT01079247.

All statistical analyses were performed by Dr. Taylor.

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Supported, in part, by the American Burn Association and funded by United States Army Medical Research and Materiel Command Award W81XWH-08-1-0760 with support from the National Center for Research Resources, National Institutes of Health, through grant UL1 RR024146, the National Center for Advancing Translational Sciences, National Institutes of Health, through grant TR 000002, and the National Center for Advancing Translational Sciences, National Institutes of Health through grant UL1 TR001860.

Drs. Cartotto’s, Taylor’s, and Bhavsar’s institutions received funding from American Burn Association (ABA) on behalf of the U.S. Department of Defense (DoD) through award United States Army Medical Research and Materiel Command Award W81XWH-08-1-0760. Drs. Cartotto, Taylor, and Pollock received support for article research from the National Institutes of Health (NIH). Dr. Taylor’s institution also received funding from the NIH. Dr. Holmes received funding from Abbott Labs, Hospira, and AbbVie, and he has equity positions in RegenMed Therapeutics, PermeaDerm, and McKesson. Drs. King and Tredget disclosed government work. Dr. Tredget’s institution received funding from the DoD (paid a expense fee for each patient completing enrollment in the multicenter study where he functioned as the principal investigator at the University of Alberta), and he disclosed he is a principal investigator for research trial sponsored by Scar X Corporation (to test an antifibrotic drug). Drs. Tredget and Greenhalgh received support for article research from the DoD. Dr. Mozingo’s institution received funding from ABA clinical trials. Dr. Greenhalgh’s institution received funding from the DoD. Dr. Palmieri’s institution received funding from Army Medical Research and Materiel Command. Dr. Peck has disclosed that he does not have any potential conflicts of interest.

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