Numbers

Context

Transfusion practices in the overall medical/surgical critical care population of patients have been extensively studied, but data pertaining specifically to critically ill brain-injured patients remain scarce as traumatic brain injury (TBI) patients were excluded or underrepresented in previous studies focused on transfusion practices. However, most critically ill patients with a TBI will develop anemia during their hospital stay, resulting in lower levels of hemoglobin which is responsible for oxygen delivery to tissues. This may result in a decrease in oxygen delivery to end organs, and more so to a fragile, traumatized brain.

Objective

The objective of the HEMOTION trial is to evaluate the effect of two red blood cell transfusion strategies on neurological function at 6 months following TBI. Participant in this trial will be randomly assigned to one of the two following strategies:

Liberal Strategy

Red blood cell transfusion if the hemoglobin level is equal to or less than 100 g/L

Restrictive strategy

Red blood cell transfusion if the hemoglobin level is equal to or less than 70 g/L

Justification

Indeed, due to the vulnerability of the brain to secondary insults, concerns have been expressed toward restrictive transfusion strategies (transfusion threshold at low hemoglobin levels) in patients with TBI. The administration of red blood cell transfusions to maintain higher hemoglobin levels and increase cerebral oxygen delivery are advocated by some experts.

To date, no consensus has been reached on an appropriate transfusion threshold in this specific critical care population as evidence-based driven data is clearly lacking. We developed a research program to establish the optimal transfusion strategy in patients with TBI. Our findings will lead to a better understanding of the brain’s blood requirements in this vulnerable population as well as a change in current transfusion practices, ensuring optimal usage of a scarce resource.

 

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