@article{ddddebdfba5a4cd791700dd7a22804f0,
title = "The Effects of Storage Age of Blood in Massively Transfused Burn Patients: A Secondary Analysis of the Randomized Transfusion Requirement in Burn Care Evaluation Study",
abstract = "Objectives: Major trials examining storage age of blood transfused to critically ill patients administered relatively few blood transfusions. We sought to determine if the storage age of blood affects outcomes when very large amounts of blood are transfused. Design: A secondary analysis of the multicenter randomized Transfusion Requirement in Burn Care Evaluation study which compared restrictive and liberal transfusion strategies. Setting: Eighteen tertiary-care burn centers. Patients: Transfusion Requirement in Burn Care Evaluation evaluated 345 adults with burns greater than or equal to 20% of the body surface area. We included only the 303 patients that received blood transfusions. Interventions: The storage ages of all transfused red cell units were collected during Transfusion Requirement in Burn Care Evaluation. A priori measures of storage age were the the mean storage age of all transfused blood and the proportion of all transfused blood considered very old (stored ≥ 35 d). Measurements and Main Results: The primary outcome was the severity of multiple organ dysfunction. Secondary outcomes included time to wound healing, the duration of mechanical ventilation, and in-hospital mortality. There were 6,786 red cell transfusions with a mean (± sd) storage age of 25.6±10.2 days. Participants received a mean of 23.4±31.2 blood transfusions (range, 1-219) and a mean of 5.3±10.7 units of very old blood. Neither mean storage age nor proportion of very old blood had any influence on multiple organ dysfunction severity, time to wound healing, or mortality. Duration of ventilation was significantly predicted by both mean blood storage age and the proportion of very old blood, but this was of questionable clinical relevance given extreme variability in duration of ventilation (adjusted r2≤ 0.01). Conclusions: Despite massive blood transfusion, including very old blood, the duration of red cell storage did not influence outcome in burn patients. Provision of the oldest blood first by Blood Banks is rational, even for massive transfusion.",
keywords = "Blood, burns, storage age, transfusion; Transfusion Requirement in Burn Care Evaluation",
author = "Robert Cartotto and Taylor, {Sandra L.} and Holmes, {James H.} and Michael Peck and Amalia Cochran and King, {Booker T.} and Daval Bhavsar and Tredget, {Edward E.} and David Mozingo and David Greenhalgh and Pollock, {Brad H.} and Palmieri, {Tina L.}",
note = "Funding Information: 10Department of Surgery, University of California, Davis and Shriners Hos-pital for Children Northern California, Sacramento, CA. Trial Registration: ClinicalTrials.gov NCT01079247. All statistical analyses were performed by Dr. Taylor. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal{\textquoteright}s website (http://journals.lww.com/ccmjournal). Supported, in part, by the American Burn Association and funded by United States Army Medical Research and Materiel Command Award W81XWH-08-1-0760 with support from the National Center for Research Resources, National Institutes of Health, through grant UL1 RR024146, the National Center for Advancing Translational Sciences, National Institutes of Health, through grant TR 000002, and the National Center for Advancing Translational Sciences, National Institutes of Health through grant UL1 TR001860. Drs. Cartotto{\textquoteright}s, Taylor{\textquoteright}s, and Bhavsar{\textquoteright}s institutions received funding from American Burn Association (ABA) on behalf of the U.S. Department of Defense (DoD) through award United States Army Medical Research and Materiel Command Award W81XWH-08-1-0760. Drs. Cartotto, Taylor, and Pollock received support for article research from the National Institutes of Health (NIH). Dr. Taylor{\textquoteright}s institution also received funding from the NIH. Dr. Holmes received funding from Abbott Labs, Hospira, and AbbVie, and he has equity positions in RegenMed Therapeutics, PermeaDerm, and McKesson. Drs. King and Tredget disclosed government work. Dr. Tredget{\textquoteright}s institution received funding from the DoD (paid a expense fee Copyright {\textcopyright} 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Publisher Copyright: {\textcopyright} 2018 Lippincott Williams and Wilkins. All rights reserved.",
year = "2018",
month = dec,
day = "1",
doi = "10.1097/CCM.0000000000003383",
language = "English (US)",
volume = "46",
pages = "E1097--E1104",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "12",
}