Reconstituted fresh whole blood improves clinical outcomes compared with stored component blood therapy for neonates undergoing cardiopulmonary bypass for cardiac surgery: A randomized controlled trial

Gruenwald, Colleen; McCrindle, Brian W.; Crawford‐Lean, Lynn; Holtby, Helen; Parshuram, Christopher S.; Massicotte, Patricia; Arsdell, Glen Van

doi:10.1016/j.jtcvs.2008.08.044

Cited by 84 publications

(74 citation statements)

References 29 publications

(34 reference statements)

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“…(35) Similarly, Gruenwald et al found that fresh reconstituted whole blood (2 days of storage) was associated with better clinical outcomes and significantly less bleeding during cardiopulmonary bypass when compared to standard blood component therapy (platelets 3–5 days old). (36) Finally, Inaba et al demonstrated that severely injured patients treated with platelets near expiration had a significant increase in septic complications. (37) Although intriguing, clearly more prospective studies are needed to clarify whether platelet storage time influences the clinical outcome of critically ill trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Increased platelet storage time is associated with mitochondrial dysfunction and impaired platelet function

Villarroel

Figueredo

Guan

et al. 2013

Journal of Surgical Research

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Background Hemorrhagic shock is a leading cause of death following severe trauma and platelet transfusions are frequently necessary to achieve hemostasis. Platelets, however, require special storage conditions and storage time has been associated with loss of platelet quality. We hypothesized that standard storage conditions have a deleterious effect on platelet mitochondrial function and platelet activation. Materials and methods Platelet donations were collected from healthy donors (n=5), and stored in gas permeable collection bags according to American Association of Blood Bank recommendations. Platelet units were sampled from day of collection (day 0) until day 7. High resolution respirometry was used to assess baseline mitochondrial respiration, maximal oxygen utilization, and individual mitochondrial complex-dependent respiration. FACS was performed to analyze mitochondrial content, mitochondrial reactive oxygen species (ROS), the expression of P-selectin (both before and after challenge with thrombin receptor activating peptide (SFLLRN)), and apoptosis. Data was analyzed using ANOVA and Pearson’s correlation (p<0.05 significant). Results Mitochondrial respiration decreased significantly in platelets stored longer than 2 days (p<0.05). Platelets also demonstrated a persistent decrease in response to stimulation with SFLLRN by the 3rd day of storage (p<0.05) as well as an increase in mitochondrial ROS and apoptosis (p<0.05). Mitochondrial respiration significantly correlated with platelet capacity to activate (r=0.8, p<0.05). Conclusion Platelet mitochondrial respiratory function and activation response decrease significantly in platelets stored for 3 or more days. Because platelet transfusions almost universally occur between the 3rd and 5th day of storage, our findings may have significant clinical importance and warrant further in vivo analysis.

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Section: Discussionmentioning

confidence: 99%

Increased platelet storage time is associated with mitochondrial dysfunction and impaired platelet function

Villarroel

Figueredo

Guan

et al. 2013

Journal of Surgical Research

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show abstract

“…[29][30][31] None of these studies evaluated clinically important consequences and none were conducted in vulnerable premature infants. In an unblinded randomized trial, Gruenwald et al 32 compared the use of fresh reconstituted whole blood to standard blood products in 64 newborns undergoing cardiac surgery. The investigators documented that transfusion of fresh reconstituted whole blood decreased chest tube blood loss, improved bleeding scores, and shortened periods of ventilation and hospital lengths of stay.…”

Section: Commentmentioning

confidence: 99%

Effect of Fresh Red Blood Cell Transfusions on Clinical Outcomes in Premature, Very Low-Birth-Weight Infants

Fergusson¹,

Hébert²,

Hogan³

et al. 2012

JAMA

389

306

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“…109 A recent report indicated that in patients with severe traumatic injury the use of fresh whole blood was independently associated with improved survival when compared to patients transfused component therapy with similar severity of injury. 19 While 2 prospective randomized-controlled trials in post-op pediatric cardiac surgery populations have indicated improved outcomes with the use of fresh whole blood compared to component therapy, 111,112 there have been no prospective trials in patients with traumatic injury. Level 1 evidence is needed to support the increased logistical support that would be required to make fresh whole blood available in large trauma centers.…”

Section: Dcr Concepts and Toolsmentioning

confidence: 99%

Resuscitation and transfusion principles for traumatic hemorrhagic shock

Spinella

Holcomb²

2009

Blood Reviews

328

246

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SUMMARY The transfusion approach to massive hemorrhage has continually evolved since it began in the early 1900s. It started with fresh whole blood and currently consists of virtually exclusive use of component and crystalloid therapy. Recent US military experience has reinvigorated the debate on what the most optimal transfusion strategy is for patients with traumatic hemorrhagic shock. In this review we discuss recently described mechanisms that contribute to traumatic coagulopathy, which include increased anticoagulation factors and hyperfibrinolysis. We also describe the concept of damage control resuscitation (DCR), an early and aggressive prevention and treatment of hemorrhagic shock for patients with severe life-threatening traumatic injuries. The central tenants of DCR include hypotensive resuscitation, rapid surgical control, prevention and treatment of acidosis, hypothermia, and hypocalcemia, avoidance of hemodilution, and hemostatic resuscitation with transfusion of red blood cells, plasma, and platelets in a 1:1:1 unit ratio and the appropriate use of coagulation factors such as rFVIIa and fibrinogen-containing products (fibrinogen concentrates, cryoprecipitate). Fresh whole blood is also part of DCR in locations where it is available. Additional concepts to DCR since its original description that can be considered are the preferential use of “fresh” RBCs, and when available thromboelastography to direct blood product and hemostatic adjunct (anti-fibrinolytics and coagulation factor) administration. Lastly we discuss the importance of an established massive transfusion protocol to rapidly employ DCR and hemostatic resuscitation principles. While the majority of recent trauma transfusion papers are supportive of these general concepts, there is no Level 1 or 2 data available. Taken together, the preponderance of data suggests that these concepts may significantly decrease mortality in massively transfused trauma patients.

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Reconstituted fresh whole blood improves clinical outcomes compared with stored component blood therapy for neonates undergoing cardiopulmonary bypass for cardiac surgery: A randomized controlled trial

Abstract: Reconstituted fresh whole blood used for the prime, throughout cardiopulmonary bypass, and for all transfusion requirements within the first 24 hours postoperatively results in reduced chest tube volume loss and improved clinical outcomes in neonatal patients undergoing cardiac surgery.

Cited by 84 publications

References 29 publications

Increased platelet storage time is associated with mitochondrial dysfunction and impaired platelet function

Increased platelet storage time is associated with mitochondrial dysfunction and impaired platelet function

Effect of Fresh Red Blood Cell Transfusions on Clinical Outcomes in Premature, Very Low-Birth-Weight Infants

Resuscitation and transfusion principles for traumatic hemorrhagic shock

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