Each year, 25 000 Canadians are hospitalized for a traumatic brain injury (TBI), by far the leading cause of permanent impairment and death in trauma. Over their intensive care unit (ICU) stay, most critically ill patients with TBI will develop anemia, which may decrease oxygen delivery to a fragile brain.
While clinical practice is moving towards transfusing patients at low hemoglobin (Hb) levels with red blood cell transfusion, several experts have expressed concerns regarding restrictive red blood cell transfusion strategies, which may adversely affect clinical outcomes in TBI. Also, current guidelines for the management of TBI are based on limited evidence and practices are highly variable, including for strategies to improve brain oxygen delivery such as red blood cell transfusion.
Thus, evidence-based driven data on what transfusion strategy to adopt in patients with TBI is unclear, as well as when benefits outweigh the risks associated with this intervention. We developed a research program to evaluate optimal transfusion strategies in patients with TBI. Our findings will allow for both optimal usage of a scarce resource and the proper understanding of the brain’s blood requirements in this vulnerable population.
In the HEMOTION trial, we hypothesize that, among critically ill adult patients with moderate or severe TBI, a liberal red blood cell transfusion strategy (triggered by Hb ≤100g/L) improves long-term functional outcomes compared to a restrictive strategy (triggered by Hb ≤70g/L). The HEMOTION trial is an international multicenter pragmatic open blinded-endpoint (PROBE) randomized trial. It is taking place in Canada and in the United Kingdom. The HEMOTION Trial is conducted in collaboration with the Canadian Traumatic Brain Injury Research Consortium (CTRC) (www.ctrc-ccrt.ca), the Canadian Critical Care Trials Group (CCCTG) (ccctg.ca) and the Perioperative Anesthesia Clinical Trials (PACT) group (www.canadianpact.ca).