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Effect of low vs. high haemoglobin transfusion trigger on cardiac output in patients undergoing elective vascular surgery: Post-hoc analysis of a randomized trial

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Møller, Anders ; Wetterslev, Jørn ; Shahidi, Saeid ; Hellemann, Dorthe ; Secher, Niels H ; Pedersen, Ole B ; Marcussen, Klaus V ; Ramsing, Benedicte G U ; Mortensen, Anette ; Nielsen, Henning B. / Effect of low vs. high haemoglobin transfusion trigger on cardiac output in patients undergoing elective vascular surgery : Post-hoc analysis of a randomized trial. In: Acta Anaesthesiologica Scandinavica. 2021 ; Vol. 65, No. 3. pp. 302-312.

Bibtex

@article{10a0373dffb6473490912eb5c2dffc9a,
title = "Effect of low vs. high haemoglobin transfusion trigger on cardiac output in patients undergoing elective vascular surgery: Post-hoc analysis of a randomized trial",
abstract = "BACKGROUND: During vascular surgery, restricted red-cell transfusion reduces frontal lobe oxygen (ScO 2 ) saturation as determined by near-infrared spectroscopy. We evaluated whether inadequate increase in cardiac output (CO) following haemodilution explains reduction in ScO 2 . METHODS: This is a post-hoc analysis of data from the Transfusion in Vascular surgery (TV) Trial where patients were randomized on haemoglobin drop below 9.7 g/dL to red-cell transfusion at haemoglobin below 8.0 (low-trigger) vs 9.7 g/dL (high-trigger). Fluid administration was guided by optimizing stroke volume. We compared mean intraoperative levels of CO, haemoglobin, oxygen delivery, and CO at nadir ScO 2 with linear regression adjusted for age, operation type and baseline. Data for 46 patients randomized before end of surgery were included for analysis. RESULTS: The low-trigger resulted in a 7.1% lower mean intraoperative haemoglobin level (mean difference, -0.74 g/dL; P < .001) and reduced volume of red-cell transfused (median [inter-quartile range], 0 [0-300] vs 450 mL [300-675]; P < .001) compared with the high-trigger group. Mean CO during surgery was numerically 7.3% higher in the low-trigger compared with the high-trigger group (mean difference, 0.36 L/min; 95% confidence interval (CI.95), -0.05 to 0.78; P = .092; n = 42). At the nadir ScO 2 -level, CO was 11.9% higher in the low-trigger group (mean difference, 0.58 L/min; CI.95, 0.10-1.07; P = .024). No difference in oxygen delivery was detected between trial groups (MD, 1.39 dL O2 /min; CI.95, -6.16 to 8.93; P = .721). CONCLUSION: Vascular surgical patients exposed to restrictive RBC transfusion elicit the expected increase in CO making it unlikely that their potentially limited cardiac capacity explains the associated ScO 2 decrease. ",
keywords = "abdominal aortic aneurysm, anaesthesia, arterial occlusive disease, erythrocyte transfusion, tissue oxygenation",
author = "Anders M{\o}ller and J{\o}rn Wetterslev and Saeid Shahidi and Dorthe Hellemann and Secher, {Niels H} and Pedersen, {Ole B} and Marcussen, {Klaus V} and Ramsing, {Benedicte G U} and Anette Mortensen and Nielsen, {Henning B}",
note = "{\textcopyright} 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",
year = "2021",
month = mar,
doi = "10.1111/aas.13733",
language = "English",
volume = "65",
pages = "302--312",
journal = "Acta Anaesthesiologica Scandinavica",
issn = "0001-5172",
publisher = "Wiley-Blackwell Munksgaard",
number = "3",

}

RIS

TY - JOUR

T1 - Effect of low vs. high haemoglobin transfusion trigger on cardiac output in patients undergoing elective vascular surgery

T2 - Post-hoc analysis of a randomized trial

AU - Møller, Anders

AU - Wetterslev, Jørn

AU - Shahidi, Saeid

AU - Hellemann, Dorthe

AU - Secher, Niels H

AU - Pedersen, Ole B

AU - Marcussen, Klaus V

AU - Ramsing, Benedicte G U

AU - Mortensen, Anette

AU - Nielsen, Henning B

N1 - © 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

PY - 2021/3

Y1 - 2021/3

N2 - BACKGROUND: During vascular surgery, restricted red-cell transfusion reduces frontal lobe oxygen (ScO 2 ) saturation as determined by near-infrared spectroscopy. We evaluated whether inadequate increase in cardiac output (CO) following haemodilution explains reduction in ScO 2 . METHODS: This is a post-hoc analysis of data from the Transfusion in Vascular surgery (TV) Trial where patients were randomized on haemoglobin drop below 9.7 g/dL to red-cell transfusion at haemoglobin below 8.0 (low-trigger) vs 9.7 g/dL (high-trigger). Fluid administration was guided by optimizing stroke volume. We compared mean intraoperative levels of CO, haemoglobin, oxygen delivery, and CO at nadir ScO 2 with linear regression adjusted for age, operation type and baseline. Data for 46 patients randomized before end of surgery were included for analysis. RESULTS: The low-trigger resulted in a 7.1% lower mean intraoperative haemoglobin level (mean difference, -0.74 g/dL; P < .001) and reduced volume of red-cell transfused (median [inter-quartile range], 0 [0-300] vs 450 mL [300-675]; P < .001) compared with the high-trigger group. Mean CO during surgery was numerically 7.3% higher in the low-trigger compared with the high-trigger group (mean difference, 0.36 L/min; 95% confidence interval (CI.95), -0.05 to 0.78; P = .092; n = 42). At the nadir ScO 2 -level, CO was 11.9% higher in the low-trigger group (mean difference, 0.58 L/min; CI.95, 0.10-1.07; P = .024). No difference in oxygen delivery was detected between trial groups (MD, 1.39 dL O2 /min; CI.95, -6.16 to 8.93; P = .721). CONCLUSION: Vascular surgical patients exposed to restrictive RBC transfusion elicit the expected increase in CO making it unlikely that their potentially limited cardiac capacity explains the associated ScO 2 decrease.

AB - BACKGROUND: During vascular surgery, restricted red-cell transfusion reduces frontal lobe oxygen (ScO 2 ) saturation as determined by near-infrared spectroscopy. We evaluated whether inadequate increase in cardiac output (CO) following haemodilution explains reduction in ScO 2 . METHODS: This is a post-hoc analysis of data from the Transfusion in Vascular surgery (TV) Trial where patients were randomized on haemoglobin drop below 9.7 g/dL to red-cell transfusion at haemoglobin below 8.0 (low-trigger) vs 9.7 g/dL (high-trigger). Fluid administration was guided by optimizing stroke volume. We compared mean intraoperative levels of CO, haemoglobin, oxygen delivery, and CO at nadir ScO 2 with linear regression adjusted for age, operation type and baseline. Data for 46 patients randomized before end of surgery were included for analysis. RESULTS: The low-trigger resulted in a 7.1% lower mean intraoperative haemoglobin level (mean difference, -0.74 g/dL; P < .001) and reduced volume of red-cell transfused (median [inter-quartile range], 0 [0-300] vs 450 mL [300-675]; P < .001) compared with the high-trigger group. Mean CO during surgery was numerically 7.3% higher in the low-trigger compared with the high-trigger group (mean difference, 0.36 L/min; 95% confidence interval (CI.95), -0.05 to 0.78; P = .092; n = 42). At the nadir ScO 2 -level, CO was 11.9% higher in the low-trigger group (mean difference, 0.58 L/min; CI.95, 0.10-1.07; P = .024). No difference in oxygen delivery was detected between trial groups (MD, 1.39 dL O2 /min; CI.95, -6.16 to 8.93; P = .721). CONCLUSION: Vascular surgical patients exposed to restrictive RBC transfusion elicit the expected increase in CO making it unlikely that their potentially limited cardiac capacity explains the associated ScO 2 decrease.

KW - abdominal aortic aneurysm

KW - anaesthesia

KW - arterial occlusive disease

KW - erythrocyte transfusion

KW - tissue oxygenation

U2 - 10.1111/aas.13733

DO - 10.1111/aas.13733

M3 - Journal article

C2 - 33141936

VL - 65

SP - 302

EP - 312

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 3

ER -

ID: 61311766