Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

M J Wozniak; N Sullo; S Qureshi; W Dott; R Cardigan; M Wiltshire; T Morris; M Nath; N Bittar; S K Bhudia; T Kumar; A H Goodall; G J Murphy

doi:10.1093/bja/aex083

Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

M J Wozniak, N Sullo, S Qureshi, W Dott, R Cardigan, M Wiltshire, T Morris, M Nath, N Bittar, S K Bhudia, T Kumar, A H Goodall, G J Murphy (Corresponding Author)

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Abstract

Background: Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.

Methods: Cardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.

Results: Sixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of 21 ( sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals -0.231, 0.709), P =0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.

Conclusions: These results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.

Clinical trial registration: ISRCTN 27076315.

Original language	English
Pages (from-to)	689-698
Number of pages	10
Journal	British Journal of Anaesthesia
Volume	118
Issue number	5
Early online date	13 Dec 2017
DOIs	https://doi.org/10.1093/bja/aex083
Publication status	Published - 2017

Bibliographical note

National Institute for Health Research Programme Grant for Applied Research (RP-PG-0407-10384 for The REDWASH trial); British Heart Foundation (RG/13/6/29947, CH/12/1/29419, and PG/11/95/29173 to G.J.M., M.W., W.D., T.K. and N.S.); Leicester Cardiovascular Biomedical Research Unit (G.J.M., M.W., W.D., T.K. and N.S.).

Keywords

Aged
Aged, 80 and over
Blood Preservation
Cardiac Surgical Procedures/adverse effects
Endothelium, Vascular
Erythrocyte Transfusion/adverse effects
Erythrocytes
Female
Hemoglobins/analysis
Humans
Interleukin-8/blood
Leukocytes/drug effects
Male
Middle Aged
Platelet Activation
Postoperative Complications/prevention & control
Single-Blind Method
Treatment Outcome

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10.1093/bja/aex083Licence: CC BY

Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery
Copyright The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/),which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Final published version, 549 KBLicence: CC BY

Cite this

Wozniak, M. J., Sullo, N., Qureshi, S., Dott, W., Cardigan, R., Wiltshire, M., Morris, T., Nath, M., Bittar, N., Bhudia, S. K., Kumar, T., Goodall, A. H., & Murphy, G. J. (2017). Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery. British Journal of Anaesthesia, 118(5), 689-698. https://doi.org/10.1093/bja/aex083

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title = "Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery",

abstract = "Background: Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.Methods: Cardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.Results: Sixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of 21 ( sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals -0.231, 0.709), P =0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.Conclusions: These results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.Clinical trial registration: ISRCTN 27076315.",

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author = "Wozniak, {M J} and N Sullo and S Qureshi and W Dott and R Cardigan and M Wiltshire and T Morris and M Nath and N Bittar and Bhudia, {S K} and T Kumar and Goodall, {A H} and Murphy, {G J}",

note = "National Institute for Health Research Programme Grant for Applied Research (RP-PG-0407-10384 for The REDWASH trial); British Heart Foundation (RG/13/6/29947, CH/12/1/29419, and PG/11/95/29173 to G.J.M., M.W., W.D., T.K. and N.S.); Leicester Cardiovascular Biomedical Research Unit (G.J.M., M.W., W.D., T.K. and N.S.). ",

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doi = "10.1093/bja/aex083",

language = "English",

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T1 - Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

AU - Wozniak, M J

AU - Sullo, N

AU - Qureshi, S

AU - Dott, W

AU - Cardigan, R

AU - Wiltshire, M

AU - Morris, T

AU - Nath, M

AU - Bittar, N

AU - Bhudia, S K

AU - Kumar, T

AU - Goodall, A H

AU - Murphy, G J

N1 - National Institute for Health Research Programme Grant for Applied Research (RP-PG-0407-10384 for The REDWASH trial); British Heart Foundation (RG/13/6/29947, CH/12/1/29419, and PG/11/95/29173 to G.J.M., M.W., W.D., T.K. and N.S.); Leicester Cardiovascular Biomedical Research Unit (G.J.M., M.W., W.D., T.K. and N.S.).

PY - 2017

Y1 - 2017

N2 - Background: Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.Methods: Cardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.Results: Sixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of 21 ( sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals -0.231, 0.709), P =0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.Conclusions: These results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.Clinical trial registration: ISRCTN 27076315.

AB - Background: Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients.Methods: Cardiac surgery patients at increased risk of large-volume RBC transfusion were eligible. Participants were randomized to receive either mechanically washed allogenic RBCs or standard care RBCs. The primary outcome was serum interleukin-8 measured at baseline and at four postsurgery time points. A mechanism substudy evaluated the effects of washing on stored RBCs in vitro and on markers of platelet, leucocyte, and endothelial activation in trial subjects.Results: Sixty adult cardiac surgery patients at three UK cardiac centres were enrolled between September 2013 and March 2015. Subjects received a median of 3.5 (interquartile range 2-5.5) RBC units, stored for a mean of 21 ( sd 5.2) days, within 48 h of surgery. Mechanical washing reduced concentrations of RBC-derived microvesicles but increased cell-free haemoglobin concentrations in RBC supernatant relative to standard care RBC supernatant. There was no difference between groups with respect to perioperative serum interleukin-8 values [adjusted mean difference 0.239 (95% confidence intervals -0.231, 0.709), P =0.318] or concentrations of plasma RBC microvesicles, platelet and leucocyte activation, plasma cell-free haemoglobin, endothelial activation, or biomarkers of heart, lung, or kidney injury.Conclusions: These results do not support a hypothesis that allogenic red blood cell washing has clinical benefits in cardiac surgery.Clinical trial registration: ISRCTN 27076315.

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KW - Female

KW - Hemoglobins/analysis

KW - Humans

KW - Interleukin-8/blood

KW - Leukocytes/drug effects

KW - Male

KW - Middle Aged

KW - Platelet Activation

KW - Postoperative Complications/prevention & control

KW - Single-Blind Method

KW - Treatment Outcome

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DO - 10.1093/bja/aex083

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SN - 0007-0912

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JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 5

ER -

Randomized trial of red cell washing for the prevention of transfusion-associated organ injury in cardiac surgery

Abstract

Bibliographical note

Keywords

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