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The following is a summary of “Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials,” published in the November 2024 issue of Critical Care by Yuan et al.
The consequences of restrictive vs liberal transfusion strategies in individuals with moderate to severe traumatic brain injury (TBI) and anemia remained inconclusive.
Researchers conducted a retrospective study to compare the impact of restrictive and liberal red blood cell transfusion strategies in adults with critical illness with moderate to severe TBI.
They searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to October 20, 2024, for randomized controlled trials (RCTs) comparing restrictive (transfusions at hemoglobin ≤ 7 g/dL) and liberal (transfusions at hemoglobin ≤ 9–10 g/dL) transfusion strategies in patients with TBI. The primary outcome was mortality, with secondary outcomes including an unfavorable neurological outcome at 6 months, assessed by the Glasgow Outcome Scale (GOS < 4) or Glasgow Outcome Scale-Extended (GOSE < 6), and the number of packed red blood cell (pRBC) units transfused.
The results showed 5 RCTs with 1,528 participants found no significant effect of restrictive transfusion on mortality (relative risk [RR] 1.00, 95% confidence interval [CI] 0.80 to 1.24, I2= 0%) or unfavorable neurological outcomes at 6 months (RR 1.06, 95% CI 0.94 to 1.20, I2= 47%). However, restrictive transfusion led to a reduction in pRBCs transfused (mean difference [MD] -2.62, 95% CI -3.33 to -1.90, I2 = 63%).
Investigators concluded the patients with TBI, a restrictive transfusion strategy did not demonstrate a significant reduction in mortality or unfavorable neurological outcomes compared to a liberal transfusion strategy.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01411-1
