Methodology: 3.5/5
Usefulness: 4/5
Taccone FS, et al. JAMA. 2024 Nov 19;332(19):1623-1633.
Question and Methods: This multicenter, randomized trial aimed to determine the optimal hemoglobin transfusion threshold in patients with acute brain injury, comparing a restrictive transfusion strategy (hgb <70g/L) with a liberal strategy (hgb<90g/L) to assess their impact on neurological outcomes.
Findings: The results showed that at 180 days following randomization, 62.6% of patients in the liberal strategy group had an unfavorable neurological outcome (GOS-E score between 1-5), compared to 72.6% in the restrictive strategy group, with a statistically significant risk difference of 10.04% (95% CI, -16.5%, -3.6%).
Limitations: Firstly, the sample size calculation for this study was adjusted twice due to slow enrolment. This was approved by ethics, but the trial protocol was published a priori. ICU clinicians were not blinded to group assignment and neuroprognostication was not standardized.
Interpretation: This RCT showed better neurologic outcomes when patients with brain injury were more liberally transfused. Despite the limitations, the findings of this paper, together with other recent related trials, are likely justification to target a liberal transfusion threshold in the ICU. Although perhaps not as relevant in the ED, we should consider a liberal threshold in brain injured patients, especially if under ED care for a prolonged time period.
JC Supervisor: Dr. Christian Vaillancourt
