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RECESS: Red cell storage duration fails to affect outcomes in patients undergoing cardiac surgery
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The duration of red cell storage before transfusion did not impact organ dysfunction in patients undergoing cardiac surgery, according to the results of the RECESS study.
Some observational studies had indicated that transfusion of red cell units stored for more than 2 or 3 weeks was associated with serious adverse events, but the issue had not been tested in a randomized controlled trial, according to the study background.
The RECESS study included 1,481 patients aged 12 years or older undergoing complex cardiac surgery who were likely to need transfusion of red cells between 2010 and 2014. Marie E. Steiner, MD, and colleagues randomly assigned patients to leukocyte-reduced red cells stored for up to 10 days or stored for at least 21 days for all intraoperative or postoperative transfusions.
The primary outcome was change in multiple organ dysfunction score (MODS), in which higher scores indicate more serious organ dysfunction, from the preoperative score to the highest composite score through 7 days, death or discharge.
The analysis included 538 patients from the shorter-term storage group (median storage time, 7 days) and 560 from the longer-term storage group (median storage time, 28 days). The other patients did not meet the criteria for evaluation, usually because they did not receive a red cell transfusion.
The mean change in MODS was an increase of 8.5 points in the shorter-term storage group and 8.7 points in the longer-term storage group (95% CI for the difference, –0.6 to 0.3; P = .44).
Seven-day mortality rates were 4.4% in the shorter-term storage group and 5.3% in the longer-term storage group (P = .57). There was no difference between the groups in adverse events except that the longer-term storage group was more likely to have a serious adverse event related to a hepatobiliary disorder (5% vs. 9%; P = .02), which the researchers attributed to more hyperbilirubinemia in the longer-term group.
“A between-group difference of 1 point or less in the change in MODS is unlikely to be clinically significant or to warrant a major change in the practice of blood banking,” Steiner, from the department of pediatrics, University of Minnesota, Minneapolis, and colleagues wrote. “Only the hepatic component of MODS, assessed by means of total serum bilirubin level, differed significantly between the groups. This finding is not unexpected because red cells hemolyze during storage.” – by Erik Swain
Disclosure: Steiner reports no relevant financial disclosures.
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