Evidence map›Paper›PMID 26385661›Full record

ReviewBritish journal of anaesthesia2015

Liberal transfusion strategy improves survival in perioperative but not in critically ill patients. A meta-analysis of randomised trials.

E Fominskiy, A Putzu, F Monaco, A M Scandroglio, A Karaskov, F R B G Galas, L A Hajjar, A Zangrillo, G Landoni

Registry-linked trialAbstract readReview
PubMed Publisher
In one paragraph

Review in British journal of anaesthesia, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05740059 (Restrictive Transfusion StratEgy Adjusted by SvO2 During Cardiac Surgery), which is not on this map. Cited by 30 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05740059 nacompletednot on this mapstarted 2023, after this paper: background citation

Restrictive Transfusion StratEgy Adjusted by SvO2 During Cardiac Surgery: Multicenter, Single-blinded, Randomised Controlled Trial.

TypeinterventionalSponsorUniversity Hospital, MontpellierRan2023 to 2025Enrolled676ConditionsCardiac Surgery, Cardiopulmonary BypassArmsAdjusted Transfusion
3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 11 syntheses or guidelines pooled it.

  1. Pooled it
  2. Transfusion thresholds for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2021
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Arquivos brasileiros de cardiologia · 2017
    Guideline
  9. Pooled it
  10. Pooled it
  11. Guideline
  12. Trial
  13. Article
  14. Article
  15. Article
  16. Liberal Transfusion versus Restrictive Transfusion and Outcomes in Critically Ill Adults: A Meta-Analysis.Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2021
    Review
  17. Article
  18. Observational
  19. Critical Care Society of Southern Africa adult patient blood management guidelines: 2019 Round-table meeting, CCSSA Congress, Durban, 2018.The Southern African journal of critical care : the official journal of the Critical Care Society · 2020
    Article
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

E FominskiyDepartment of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia.
A PutzuDepartment of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
F MonacoDepartment of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
A M ScandroglioDepartment of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
A KaraskovAcademician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia.
F R B G GalasSurgical Intensive Care Unit and Department of Anaesthesiology, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
L A HajjarSurgical Intensive Care Unit and Department of Anaesthesiology, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
A ZangrilloDepartment of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy Vita-Salute San Raffaele University of Milan, Italy.
G LandoniDepartment of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy Vita-Salute San Raffaele University of Milan, Italy landoni.giovanni@hsr.it.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGuidelines support the use of a restrictive strategy in blood transfusion management in a variety of clinical settings. However, recent randomized controlled trials (RCTs) performed in the perioperative setting suggest a beneficial effect on survival of a liberal strategy. We aimed to assess the effect of liberal and restrictive blood transfusion strategies on mortality in perioperative and critically ill adult patients through a meta-analysis of RCTs.

methodsWe searched PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, Transfusion Evidence Library, and Google Scholar up to 27 March 2015, for RCTs performed in perioperative or critically ill adult patients, receiving a restrictive or liberal transfusion strategy, and reporting all-cause mortality. We used a fixed or random-effects model to calculate the odds ratio (OR) and 95% confidence interval (CI) for pooled data. We assessed heterogeneity using Cochrane's Q and I(2) tests. The primary outcome was all-cause mortality within 90-day follow-up.

resultsPatients in the perioperative period receiving a liberal transfusion strategy had lower all-cause mortality when compared with patients allocated to receive a restrictive transfusion strategy (OR 0.81; 95% CI 0.66‒1.00; P=0.05; I(2)=25%; Number needed to treat=97) with 7552 patients randomized in 17 trials. There was no difference in mortality among critically ill patients receiving a liberal transfusion strategy when compared with the restrictive transfusion strategy (OR 1.10; 95% CI 0.99‒1.23; P=0.07; I(2)=34%) with 3469 patients randomized in 10 trials.

conclusionAccording to randomized published evidence, perioperative adult patients have an improved survival when receiving a liberal blood transfusion strategy.

Indexed as

Randomized Controlled Trials as TopicBlood TransfusionCritical CareCritical IllnessHumansPerioperative CareSurvival AnalysisTreatment Outcomeanesthesiablood transfusioncritical illnessmortalityperioperative care

Identifiers

PMID26385661

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.