Transfusion requirements after head trauma: a randomized feasibility controlled trial.

Area of Science:

• Neuroscience
• Critical Care Medicine
• Hematology

Background:

• Anemia is common in traumatic brain injury (TBI) patients, correlating with poorer outcomes.
• The optimal hemoglobin threshold for red blood cell (RBC) transfusion in TBI is not well-established.

Purpose of the Study:

• To compare the effects of restrictive versus liberal hemoglobin transfusion strategies on outcomes in moderate to severe TBI patients.

Main Methods:

• Adult TBI patients in the ICU were randomized to a restrictive (7 g/dL) or liberal (9 g/dL) hemoglobin transfusion threshold.
• Transfusion strategies were maintained for up to 14 days or ICU discharge.
• Outcomes included transfusion needs, intracranial pressure, cerebral hemodynamics, length of stay, mortality, and 6-month neurological function.

Main Results:

• The liberal group maintained higher mean hemoglobin levels (9.3 g/dL vs. 8.4 g/dL) and received more RBC units.
• Lower incidence of post-traumatic vasospasm was observed in the liberal group (3% vs. 65%).
• Hospital mortality was significantly lower in the liberal group (1/21 vs. 7/23), with a trend towards better 6-month neurological status.

Conclusions:

• A liberal RBC transfusion strategy (9 g/dL threshold) appears feasible and potentially beneficial in TBI patients.
• This strategy led to reduced hospital mortality and improved neurological outcomes compared to a restrictive approach.