The effects of cryopreserved red blood cell transfusion on tissue oxygenation in obese trauma patients

Belinda H. McCully; Samantha J. Underwood; Laszlo Kiraly; John B. Holcomb; Bryce R.H. Robinson; Joseph P. Minei; Ronald M. Stewart; Bryan A. Cotton; Nicole T. Gordon; David T. Martin; Elizabeth A. Rick; Rondi K. Dean; Connor Wiles; Nathan Anderson; Martin A. Schreiber

doi:10.1097/TA.0000000000001717

The effects of cryopreserved red blood cell transfusion on tissue oxygenation in obese trauma patients

Belinda H. McCully, Samantha J. Underwood, Laszlo Kiraly, John B. Holcomb, Bryce R.H. Robinson, Joseph P. Minei, Ronald M. Stewart, Bryan A. Cotton, Nicole T. Gordon, David T. Martin, Elizabeth A. Rick, Rondi K. Dean, Connor Wiles, Nathan Anderson, Martin A. Schreiber

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

BACKGROUND Low tissue oxygenation (StO₂) is associated with poor outcomes in obese trauma patients. A novel treatment could be the transfusion of cryopreserved packed red blood cells (CPRBCs), which the in vitro biochemical profile favors red blood cell (RBC) function. We hypothesized that CPRBC transfusion improves StO₂ in obese trauma patients. METHODS Two hundred forty-three trauma patients at five Level I trauma centers who required RBC transfusion were randomized to receive one to two units of liquid packed RBCs (LPRBCs) or CPRBCs. Demographics, injury severity, StO₂, outcomes, and biomarkers of RBC function were compared in nonobese (body mass index [BMI] < 30) and obese (BMI ≥ 30) patients. StO₂ was also compared between obese patients with BMI of 30 to 34.9 and BMI ≥ 35. StO₂ was normalized and expressed as % change after RBC transfusion. A p value less than 0.05 indicated significance. RESULTS Patients with BMI less than 30 (n = 141) and BMI of 30 or greater (n = 102) had similar Injury Severity Score, Glasgow Coma Scale, and baseline StO₂. Plasma levels of free hemoglobin, an index of RBC lysis, were lower in obese patients after CPRBC (125 [72-259] μg/mL) versus LPRBC transfusion (230 [178-388] μg/mL; p < 0.05). StO₂ was similar in nonobese patients regardless of transfusion type, but improved in obese patients who received CPRBCs (104 ± 1%) versus LPRPCs (99 ± 1%, p < 0.05; 8 hours after transfusion). Subanalysis showed improved StO₂ after CPRBC transfusion was specific to BMI of 35 or greater, starting 5 hours after transfusion (p < 0.05 vs. LPRBCs). CPRBCs did not improve clinical outcomes in either group. CONCLUSION CPRBC transfusion is associated with increased StO₂ and lower free hemoglobin levels in obese trauma patients, but did not improve clinical outcomes. Future studies are needed to determine if CPRBC transfusion in obese patients attenuates hemolysis to improve StO₂. LEVEL OF EVIDENCE Therapeutic, level IV.

Original language	English (US)
Pages (from-to)	104-111
Number of pages	8
Journal	Journal of Trauma and Acute Care Surgery
Volume	84
Issue number	1
DOIs	https://doi.org/10.1097/TA.0000000000001717
State	Published - Jan 1 2018

Keywords

Obesity
cryopreservation
red blood cell
trauma

ASJC Scopus subject areas

Surgery
Critical Care and Intensive Care Medicine

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10.1097/TA.0000000000001717

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McCully, B. H., Underwood, S. J., Kiraly, L., Holcomb, J. B., Robinson, B. R. H., Minei, J. P., Stewart, R. M., Cotton, B. A., Gordon, N. T., Martin, D. T., Rick, E. A., Dean, R. K., Wiles, C., Anderson, N., & Schreiber, M. A. (2018). The effects of cryopreserved red blood cell transfusion on tissue oxygenation in obese trauma patients. Journal of Trauma and Acute Care Surgery, 84(1), 104-111. https://doi.org/10.1097/TA.0000000000001717

McCully, BH, Underwood, SJ, Kiraly, L, Holcomb, JB, Robinson, BRH, Minei, JP, Stewart, RM, Cotton, BA, Gordon, NT, Martin, DT, Rick, EA, Dean, RK, Wiles, C, Anderson, N & Schreiber, MA 2018, 'The effects of cryopreserved red blood cell transfusion on tissue oxygenation in obese trauma patients', Journal of Trauma and Acute Care Surgery, vol. 84, no. 1, pp. 104-111. https://doi.org/10.1097/TA.0000000000001717

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title = "The effects of cryopreserved red blood cell transfusion on tissue oxygenation in obese trauma patients",

abstract = "BACKGROUND Low tissue oxygenation (StO2) is associated with poor outcomes in obese trauma patients. A novel treatment could be the transfusion of cryopreserved packed red blood cells (CPRBCs), which the in vitro biochemical profile favors red blood cell (RBC) function. We hypothesized that CPRBC transfusion improves StO2 in obese trauma patients. METHODS Two hundred forty-three trauma patients at five Level I trauma centers who required RBC transfusion were randomized to receive one to two units of liquid packed RBCs (LPRBCs) or CPRBCs. Demographics, injury severity, StO2, outcomes, and biomarkers of RBC function were compared in nonobese (body mass index [BMI] < 30) and obese (BMI ≥ 30) patients. StO2 was also compared between obese patients with BMI of 30 to 34.9 and BMI ≥ 35. StO2 was normalized and expressed as % change after RBC transfusion. A p value less than 0.05 indicated significance. RESULTS Patients with BMI less than 30 (n = 141) and BMI of 30 or greater (n = 102) had similar Injury Severity Score, Glasgow Coma Scale, and baseline StO2. Plasma levels of free hemoglobin, an index of RBC lysis, were lower in obese patients after CPRBC (125 [72-259] μg/mL) versus LPRBC transfusion (230 [178-388] μg/mL; p < 0.05). StO2 was similar in nonobese patients regardless of transfusion type, but improved in obese patients who received CPRBCs (104 ± 1%) versus LPRPCs (99 ± 1%, p < 0.05; 8 hours after transfusion). Subanalysis showed improved StO2 after CPRBC transfusion was specific to BMI of 35 or greater, starting 5 hours after transfusion (p < 0.05 vs. LPRBCs). CPRBCs did not improve clinical outcomes in either group. CONCLUSION CPRBC transfusion is associated with increased StO2 and lower free hemoglobin levels in obese trauma patients, but did not improve clinical outcomes. Future studies are needed to determine if CPRBC transfusion in obese patients attenuates hemolysis to improve StO2. LEVEL OF EVIDENCE Therapeutic, level IV.",

keywords = "Obesity, cryopreservation, red blood cell, trauma",

author = "McCully, {Belinda H.} and Underwood, {Samantha J.} and Laszlo Kiraly and Holcomb, {John B.} and Robinson, {Bryce R.H.} and Minei, {Joseph P.} and Stewart, {Ronald M.} and Cotton, {Bryan A.} and Gordon, {Nicole T.} and Martin, {David T.} and Rick, {Elizabeth A.} and Dean, {Rondi K.} and Connor Wiles and Nathan Anderson and Schreiber, {Martin A.}",

year = "2018",

month = jan,

day = "1",

doi = "10.1097/TA.0000000000001717",

language = "English (US)",

volume = "84",

pages = "104--111",

journal = "Journal of Trauma and Acute Care Surgery",

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T1 - The effects of cryopreserved red blood cell transfusion on tissue oxygenation in obese trauma patients

AU - McCully, Belinda H.

AU - Underwood, Samantha J.

AU - Kiraly, Laszlo

AU - Holcomb, John B.

AU - Robinson, Bryce R.H.

AU - Minei, Joseph P.

AU - Stewart, Ronald M.

AU - Cotton, Bryan A.

AU - Gordon, Nicole T.

AU - Martin, David T.

AU - Rick, Elizabeth A.

AU - Dean, Rondi K.

AU - Wiles, Connor

AU - Anderson, Nathan

AU - Schreiber, Martin A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND Low tissue oxygenation (StO2) is associated with poor outcomes in obese trauma patients. A novel treatment could be the transfusion of cryopreserved packed red blood cells (CPRBCs), which the in vitro biochemical profile favors red blood cell (RBC) function. We hypothesized that CPRBC transfusion improves StO2 in obese trauma patients. METHODS Two hundred forty-three trauma patients at five Level I trauma centers who required RBC transfusion were randomized to receive one to two units of liquid packed RBCs (LPRBCs) or CPRBCs. Demographics, injury severity, StO2, outcomes, and biomarkers of RBC function were compared in nonobese (body mass index [BMI] < 30) and obese (BMI ≥ 30) patients. StO2 was also compared between obese patients with BMI of 30 to 34.9 and BMI ≥ 35. StO2 was normalized and expressed as % change after RBC transfusion. A p value less than 0.05 indicated significance. RESULTS Patients with BMI less than 30 (n = 141) and BMI of 30 or greater (n = 102) had similar Injury Severity Score, Glasgow Coma Scale, and baseline StO2. Plasma levels of free hemoglobin, an index of RBC lysis, were lower in obese patients after CPRBC (125 [72-259] μg/mL) versus LPRBC transfusion (230 [178-388] μg/mL; p < 0.05). StO2 was similar in nonobese patients regardless of transfusion type, but improved in obese patients who received CPRBCs (104 ± 1%) versus LPRPCs (99 ± 1%, p < 0.05; 8 hours after transfusion). Subanalysis showed improved StO2 after CPRBC transfusion was specific to BMI of 35 or greater, starting 5 hours after transfusion (p < 0.05 vs. LPRBCs). CPRBCs did not improve clinical outcomes in either group. CONCLUSION CPRBC transfusion is associated with increased StO2 and lower free hemoglobin levels in obese trauma patients, but did not improve clinical outcomes. Future studies are needed to determine if CPRBC transfusion in obese patients attenuates hemolysis to improve StO2. LEVEL OF EVIDENCE Therapeutic, level IV.

AB - BACKGROUND Low tissue oxygenation (StO2) is associated with poor outcomes in obese trauma patients. A novel treatment could be the transfusion of cryopreserved packed red blood cells (CPRBCs), which the in vitro biochemical profile favors red blood cell (RBC) function. We hypothesized that CPRBC transfusion improves StO2 in obese trauma patients. METHODS Two hundred forty-three trauma patients at five Level I trauma centers who required RBC transfusion were randomized to receive one to two units of liquid packed RBCs (LPRBCs) or CPRBCs. Demographics, injury severity, StO2, outcomes, and biomarkers of RBC function were compared in nonobese (body mass index [BMI] < 30) and obese (BMI ≥ 30) patients. StO2 was also compared between obese patients with BMI of 30 to 34.9 and BMI ≥ 35. StO2 was normalized and expressed as % change after RBC transfusion. A p value less than 0.05 indicated significance. RESULTS Patients with BMI less than 30 (n = 141) and BMI of 30 or greater (n = 102) had similar Injury Severity Score, Glasgow Coma Scale, and baseline StO2. Plasma levels of free hemoglobin, an index of RBC lysis, were lower in obese patients after CPRBC (125 [72-259] μg/mL) versus LPRBC transfusion (230 [178-388] μg/mL; p < 0.05). StO2 was similar in nonobese patients regardless of transfusion type, but improved in obese patients who received CPRBCs (104 ± 1%) versus LPRPCs (99 ± 1%, p < 0.05; 8 hours after transfusion). Subanalysis showed improved StO2 after CPRBC transfusion was specific to BMI of 35 or greater, starting 5 hours after transfusion (p < 0.05 vs. LPRBCs). CPRBCs did not improve clinical outcomes in either group. CONCLUSION CPRBC transfusion is associated with increased StO2 and lower free hemoglobin levels in obese trauma patients, but did not improve clinical outcomes. Future studies are needed to determine if CPRBC transfusion in obese patients attenuates hemolysis to improve StO2. LEVEL OF EVIDENCE Therapeutic, level IV.

KW - Obesity

KW - cryopreservation

KW - red blood cell

KW - trauma

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The effects of cryopreserved red blood cell transfusion on tissue oxygenation in obese trauma patients

Abstract

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