Haemoglobin transfusion threshold in traumatic brain injury optimisation (HEMOTION): a multicentre, randomised,...

Area of Science:

• Neuroscience
• Critical Care Medicine
• Hematology

Background:

• Traumatic brain injury (TBI) is a major cause of death and disability in young adults.
• The optimal hemoglobin (Hb) transfusion threshold for TBI patients with anemia remains undetermined.
• Red blood cell transfusion is common in TBI management, highlighting the need for evidence-based guidelines.

Purpose of the Study:

• To compare a liberal hemoglobin transfusion strategy against a restrictive strategy in adult patients with moderate to severe TBI.
• To determine if a liberal transfusion approach improves clinical outcomes in TBI patients.
• To evaluate the impact of different transfusion thresholds on functional independence, quality of life, and mortality.

Main Methods:

• An international, pragmatic, randomized, open-label, blinded-endpoint trial involving 742 adult ICU patients with acute moderate/severe blunt TBI (GCS ≤12) and Hb ≤100 g/L.
• Patients were stratified by site and randomized 1:1 to either a liberal (Hb ≤100 g/L) or restrictive (Hb ≤70 g/L) transfusion strategy.
• Outcomes, including the primary endpoint (extended Glasgow Outcome Scale at 6 months), were assessed by blinded personnel.

Main Results:

• The study is ongoing, and results are not yet available.
• The trial aims to provide critical data on the efficacy of different hemoglobin transfusion thresholds.
• Analysis will focus on the primary outcome of extended Glasgow Outcome Scale at 6 months and various secondary outcomes.

Conclusions:

• The findings will inform clinical practice guidelines for red blood cell transfusion in TBI management.
• Establishing an optimal Hb transfusion threshold could improve patient recovery and reduce long-term disability.
• This research addresses a significant knowledge gap in the critical care of TBI patients.