Restrictive transfusion strategy is more effective in massive burns: Results of the TRIBE multicenter prospective randomized trial

Objectives: Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: Compare outcomes between massive burn (.60% total body surface area (TBSA) burn) and major (20.59% TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods: Patients with burns .20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin 7 g/dL) or liberal (transfuse hemoglobin 10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results: Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 } 47.63 vs. 77.16 ± 55.0, p 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p > 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20.59%) group (p > 0.05). Conclusions:: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.