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The following is a summary of “Transfusion Practices in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” published in the January 2025 issue of Critical Care by Larcipretti et al.
Researchers conducted a retrospective study to compare liberal and restrictive transfusion strategies in individuals with traumatic brain injury (TBI).
They searched electronic databases from inception to October 2024. Randomized controlled trials comparing liberal and restrictive transfusion strategies in individuals with TBI were included and data extraction was performed by 2 reviewers using predefined forms.
The results showed 5 studies with 1,533 individuals were included: 769 (50.2%) in the liberal transfusion group and 764 (49.8%) in the restrictive group. No significant differences were observed in favorable Glasgow Outcome Scale scores (risk ratio [RR], 1.16; 95% CI, 1.00–1.34), though leave-one-out analysis indicated significance (RR, 1.24; 95% CI, 1.06–1.45). Hospital mortality (RR, 0.98; 95% CI, 0.76–1.27), follow-up mortality (RR, 1.03; 95% CI, 0.82–1.28), ICU mortality (RR, 1.00; 95% CI, 0.73–1.37), infection rates (RR, 1.08; 95% CI, 0.95–1.23), thromboembolic events (RR, 1.79; 95% CI, 0.74–4.31), hospital length of stay (LOS) (mean difference [MD], –1.45; 95% CI, –4.85 to 1.96), and ICU stay (MD, –0.47; 95% CI, –3.84 to 2.91) showed no significant differences. Acute respiratory distress syndrome was higher in the liberal group (RR, 1.78; 95% CI, 1.06–2.98), who also received more blood units per individual (MD, 2.62; 95% CI, 1.90–3.33).
Investigators concluded a liberal transfusion strategy resulted in better neurologic outcomes than a restrictive approach and suggested revising current guidelines to establish 9 g/dL as the standard transfusion threshold for patients with TBI.
