The effects of cryopreserved red blood cell transfusion on tissue oxygenation in obese trauma patients

The effects of cryopreserved red blood cell transfusion on tissue oxygenation in obese trauma... ABSTRACT Background Low tissue oxygenation (StO2) is associated with poor outcomes in obese trauma patients. A novel treatment could be the transfusion of cryopreserved packed red blood cells (CPRBCs), which the in vitro biochemical profile favors RBC function. We hypothesized that CPRBC transfusion improves StO2 in obese trauma patients. Methods 243 trauma patients at five Level 1 trauma centers who required RBC transfusion were randomized to receive 1-2 units of liquid PRBCs (LPRBCs) or CPRBCs. Demographics, injury severity, StO2, outcomes, and biomarkers of RBC function were compared in non-obese (BMI<30) and obese (BMI≥30) patients. StO2 was also compared between obese patients with BMI of 30-34.9 and BMI≥35. StO2 was normalized and expressed as % change following RBC transfusion. p<0.05 indicated significance. Results Patients with BMI<30 (n=141) and BMI≥30, (n=102) had similar ISS, GCS, and baseline StO2. Plasma levels of free hemoglobin, an index of RBC lysis, were lower in obese patients following CPRBC (125 (72-259) μg/ml) versus LPRBC transfusion (230 (178-388) μg/ml; p<0.05). StO2 was similar in non-obese patients regardless of transfusion type, but improved in obese patients who received CPRBCs (104±1%) versus LPRPCs (99±1%, p<0.05; 8hrs following transfusion). Subanalysis showed improved StO2 following CPRBC transfusion was specific to BMI≥35, starting 5hrs following transfusion (p<0.05 vs LPRBCs). CPRBCs did not improve clinical outcomes in either group. Conclusion CPRBC transfusion is associated with increased StO2 and lower free hemoglobin levels in obese trauma patients, but did not improve clinical outcomes. Future studies are needed to determine if CPRBC transfusion in obese patients attenuates hemolysis to improve StO2. Level of Evidence Level IV, therapeutic http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Journal of Trauma and Acute Care Surgery Wolters Kluwer Health

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Publisher
Lippincott Williams & Wilkins
Copyright
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
2163-0755
eISSN
2163-0763
D.O.I.
10.1097/TA.0000000000001717
Publisher site
See Article on Publisher Site

Abstract

ABSTRACT Background Low tissue oxygenation (StO2) is associated with poor outcomes in obese trauma patients. A novel treatment could be the transfusion of cryopreserved packed red blood cells (CPRBCs), which the in vitro biochemical profile favors RBC function. We hypothesized that CPRBC transfusion improves StO2 in obese trauma patients. Methods 243 trauma patients at five Level 1 trauma centers who required RBC transfusion were randomized to receive 1-2 units of liquid PRBCs (LPRBCs) or CPRBCs. Demographics, injury severity, StO2, outcomes, and biomarkers of RBC function were compared in non-obese (BMI<30) and obese (BMI≥30) patients. StO2 was also compared between obese patients with BMI of 30-34.9 and BMI≥35. StO2 was normalized and expressed as % change following RBC transfusion. p<0.05 indicated significance. Results Patients with BMI<30 (n=141) and BMI≥30, (n=102) had similar ISS, GCS, and baseline StO2. Plasma levels of free hemoglobin, an index of RBC lysis, were lower in obese patients following CPRBC (125 (72-259) μg/ml) versus LPRBC transfusion (230 (178-388) μg/ml; p<0.05). StO2 was similar in non-obese patients regardless of transfusion type, but improved in obese patients who received CPRBCs (104±1%) versus LPRPCs (99±1%, p<0.05; 8hrs following transfusion). Subanalysis showed improved StO2 following CPRBC transfusion was specific to BMI≥35, starting 5hrs following transfusion (p<0.05 vs LPRBCs). CPRBCs did not improve clinical outcomes in either group. Conclusion CPRBC transfusion is associated with increased StO2 and lower free hemoglobin levels in obese trauma patients, but did not improve clinical outcomes. Future studies are needed to determine if CPRBC transfusion in obese patients attenuates hemolysis to improve StO2. Level of Evidence Level IV, therapeutic

Journal

The Journal of Trauma and Acute Care SurgeryWolters Kluwer Health

Published: Apr 1, 2017

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