Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery.pdf (536.03 kB)
Download file

Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

Download (536.03 kB)
journal contribution
posted on 14.08.2017, 14:55 by Marcin J. Woźniak, N. Sullo, S. Qureshi, W. Dott, R. Cardigan, M. Wiltshire, T. Morris, M. Nath, N. Bittar, S. K. Bhudia, T. Kumar, A. H. Goodall, G. J. Murphy
Background: Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients. Methods: Cardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects. Results: Sixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of 21 ( sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals -0.231, 0.709), P =0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury. Conclusions: These results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery. Clinical trial registration: ISRCTN 27076315.

History

Citation

British Journal of Anaesthesia, 2017, 118 (5), pp. 689-698

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

British Journal of Anaesthesia

Publisher

Oxford University Press (OUP)

issn

0007-0912

eissn

1471-6771

Acceptance date

28/02/2017

Copyright date

2017

Available date

14/08/2017

Publisher version

https://academic.oup.com/bja/article-lookup/doi/10.1093/bja/aex083

Language

en

Usage metrics

Categories

Licence

Exports