Objective:

The efficacy and safety of liberal transfusion strategy versus restrictive transfusion strategy in patients with traumatic head injury remain to be fully explored.

Background:

Design/Methods:

PubMed, Embase and Cochrane databases were searched for randomized controlled trials (RCTs) comparing liberal versus restrictive transfusion strategies in patients with traumatic brain injury with primary outcomes of Intensive care unit (ICU) and in-hospital mortalities. Heterogeneity was examined with I² statistics. A random-effects model was used for outcomes with high heterogeneity

 

Results:

We included 3 RCTs comparing liberal versus restrictive transfusion strategies. The pooled results showed that the ICU mortality (RR = 0.75; 95% CI [0.30; 1.88]; p = 0.537), in-hospital mortality (RR = 0.82; 95% CI [0.42; 1.61]; p = 0.560), stroke (RR = 1.82; 95% CI [0.57; 5.78]; p = 0.313), sepsis (RR = 0.67; 95% CI [0.42; 1.06]; p = 0.086), pneumonia (RR = 0.97; 95% CI [0.64; 1.47]; p = 0.890), deep venous thrombosis (DVT) (RR = 1.67; 95% CI [0.34; 8.27]; p = 0.527), surgical site infection (SSI) (RR = 0.72; 95% CI [0.29; 1.78]; p = 0.480), and pulmonary embolism (PE) (RR = 1.20; 95% CI [0.53; 2.75]; p = 0.660) were not significantly different between groups. However, liberal transfusion strategy increases the incidence of adult respiratory distress syndrome (ARDS) (RR = 3.17; 95% CI [1.01; 9.90]; p = 0.048) as well as the number of red blood cell (RBC) units received per patient (p < 0.001). There were no significant differences between groups for lengths of ICU stay (p = 0.777) and hospital stay (p = 0.605).

Conclusions:

Our meta-analysis showed that liberal transfusion strategy did not reduce ICU and in-hospital mortalities compared to restrictive transfusion strategy.