Longer Transfused Red-Cell Storage Doesn't Worsen Cardiac Surgery Outcomes: Randomized Trial

April 09, 2015

BOSTON, MA — There's no important clinical benefit from preferring red blood cells (RBC) that have been stored for <10 days vs at least 3 weeks for use in patients undergoing major cardiac surgery, suggests a randomized trial published in the April 9, 2015 issue of the New England Journal of Medicine[1].

The multicenter Red-Cell Storage Duration Study (RECESS), with its >1000 patients aged 12 years or older, saw no significant differences between use of the two types of stored erythrocytes in an end point reflecting onset of multiple organ dysfunction or mortality at either 7 or 28 days after surgery or in length of intensive-care–unit (ICU) stay.

Although some observational studies have seen a hazard from longer RBC storage times, the current authors, led by Dr Marie E Steiner (Fairview-University Medical Center, Minneapolis, MN), state that "the results of randomized clinical trials in different patient groups do not support restricting red-cell transfusion to units stored for a shorter period than that indicated by the current licensed expiration dates."

Indeed, in the same issue of the journal, Dr Jacques Lacroix (Université de Montréal, QC) and colleagues reported that use of RBCs stored <8 days vs an average of 3 weeks conferred no 90-day survival advantage when given to critically ill patients in tertiary-care–center ICUs[2]. Nor, in that international randomized trial with >1200 patients, called the Age of Blood Evaluation (ABLE) study, were there significant differences between the patient groups in major morbidities, ICU mortality, or length of stay.

"We surmise that the use of fresh red cells is not justified at this time," Lacroix et al write. "We might also infer that changes to red cells or the storage medium that have been documented in many laboratory studies may have limited clinical consequences."

Transfusions From "Complex Cardiac Surgery"

RECESS randomized patients at least 12 years old scheduled for "complex cardiac surgery with planned median sternotomy," with those 18 years or older also judged by a validated index to have a 60% chance of receiving RBCs the day of or day after surgery.

Surgery in the 538 patients who received RBCs stored up to 10 days (median 7 days) and the 560 who received red cells stored for at least 21 days (median 28 days) overwhelmingly consisted of CABG, valve repair or replacement, or both.

They note that in the US, the mean storage time for transfused RBCs is 17.9 days.

The primary end point, mean change in Multiple Organ Dysfunction Score (MODS), was 8.5 and 8.7 for shorter-term and longer-term RBC storage, respectively (P=0.44), "which is clearly not a difference of any clinical importance," according to the authors.

Their study doesn't preclude an effect of RBC storage time on surgery outcomes for other patient populations, they observe, pointing out the ongoing the Age of Blood in Children in Pediatric Intensive Care Units with a projected >1500 patients scheduled for completion in 2018.

The RECESS trial was supported by the National Heart, Lung, and Blood Institute. Steiner has no relevant financial relationships; disclosures for the coauthors are available on the journal website. The ABLE trial was funded by the Canadian Institutes of Health Research and others. Lacroix has no relevant financial relationships; disclosures for the coauthors are available on the journal website.

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