Red blood cell storage duration does not affect outcomes after cardiac surgery

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 - Red Blood Cells

A randomized trial of patients undergoing complex cardiac surgery found that the duration of red blood cells stored for transfusions was not associated with a significant change in the Multiple Organ Dysfunction Score (MODS) seven days after the operation.

Lead researcher Marie E. Steiner, MD, of the Fairview–University Medical Center in Minneapolis, and colleagues presented their results online April 8 in the New England Journal of Medicine.

The RECESS (Red-Cell Storage Duration Study) trial included 1,481 patients at 33 U.S. hospitals who were randomized between 2010 and 2014 to receive red blood cell units stored for 10 days or less or to receive red blood cell units stored for 21 days or more. They received those red blood cells for each transfusion from the time they were randomized until 28 days after the operation, hospital discharge or death.

The mean durations of storage were 7.8 days in the shorter-term storage group and 28.3 days in the longer-term storage group.

Patients had to be at least 12 years of age and weigh at least 40 kg. Patients who were at least 18 years of age also had to have a score of 3 or higher on the Transfusion Risk Understanding Scoring Tool.

The median age of patients at baseline was 72 years, while 57 percent were females and the mean MODS at baseline was 0.7 points. The MODS ranges from 0 to 24 points, and a higher score means the person has more severe organ dysfunction.

The mean seven-day change in MODS was 8.5 points in the shorter-term storage group and 8.7 points in the longer-term storage group. Researchers said the only MODS component that had a significant difference between the groups was in the total serum bilirubin levels.

There was also no significant difference in all-cause mortality. By day seven after the surgeries, 2.8 percent of patients in the shorter-term storage group and 2 percent of patients in the longer-term storage group had died. By day 28, 4.4 percent of patients in the shorter-term storage group and 5.3 percent of patients in the longer-term storage group had died.

In addition, researchers said there were no significant differences in the 28-day change in MODS, the length of hospital stay or the length of stay in the intensive care unit. Further, the mean number of serious adverse events per patient was 1.6 in each group.