Effect of Fresh vs Standard-issue Red Blood Cell Transfusions on Multiple Organ Dysfunction Syndrome in Critically Ill Pediatric Patients: A Randomized Clinical Trial.
Creators: name: Spinella, Philip C
name: Tucci, Marisa
name: Fergusson, Dean A
name: Lacroix, Jacques
name: Hébert, Paul C
name: Leteurtre, Stéphane
name: Schechtman, Kenneth B
name: Doctor, Allan
name: Berg, Robert A
name: Bockelmann, Tina
name: Caro, J Jaime
name: Chiusolo, Fabrizio
name: Clayton, Lucy
name: Cholette, Jill M
name: Guerra, Gonzalo Garcia
name: Josephson, Cassandra D
name: Menon, Kusum
name: Muszynski, Jennifer A
name: Nellis, Marianne E
name: Sarpal, Amrita
name: Schafer, Stephanie
name: Steiner, Marie E
name: Turgeon, Alexis F
name: ABC-PICU Investigators, The Canadian Critical Care Trials Group
Publisher: name: American Medical Association (AMA)
Year: 2019
Subjects: Adolescent
Blood Preservation
Child
Child, Preschool
Critical Illness
Disease Progression
Erythrocyte Transfusion
Female
Hospital Mortality
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Kaplan-Meier Estimate
Male
Multiple Organ Failure
Patient Acuity
Respiratory Distress Syndrome, Newborn
Sepsis

description: IMPORTANCE: The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial. OBJECTIVE: To determine if the transfusion of fresh red blood cells (stored ≤7 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children. DESIGN, SETTING, AND PARTICIPANTS: The Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15 568 patients were screened, and 13 308 were excluded. INTERVENTIONS: Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group. MAIN OUTCOMES AND MEASURES: The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death. RESULTS: Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P &lt; .001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, -2.0% to 6.1%; P = .33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P = .34). CONCLUSIONS AND RELEVANCE: Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01977547.