ArticleJournal of intensive care2023
The Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial: a cluster-randomized, crossover, non-inferiority multicenter trial of restrictive transfusion in trauma.
Article in Journal of intensive care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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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.
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.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- Transfusion thresholds and other strategies for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2025Pooled it
- Blood transfusion strategies for major bleeding in trauma.The Cochrane database of systematic reviews · 2025Pooled it
- Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial.World journal of emergency surgery : WJES · 2024Trial
- Effect of head injury on blood transfusion requirements in severe trauma: a post-hoc analysis of the RESTRIC trial.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Molecular Mechanisms of Transfusion-Associated Immunomodulation and Its Impact in the Critically Ill.International journal of molecular sciences · 2025Review
- Assessing the carbon footprint of the initial 24 h post-severe trauma admission in a French ICU: a pilot study.Annals of intensive care · 2025Article
- The Red-cell Transfusion Strategy Dilemma in Critically Ill Patients in ICU: Is Restrictive or Liberal the Answer?Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH · 2025Review
- Real-world efficacy of transfusion with liberal or restrictive strategy in traumatic brain injury.Annals of clinical and translational neurology · 2025Article
- Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Anemia tolerance.Hematology, transfusion and cell therapy · 2024Article
- Is Vesicular Therapy the Newcomer That Matters for the Medicine of Tomorrow?International journal of molecular sciences · 2024Article
- Adherence to balanced transfusion among severely injured patients: A post hoc analysis of the RESTRIC trial.Acute medicine & surgeryArticle
Corrections and comments
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Authors and funding
30 authors at 20 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe efficacies of fresh frozen plasma and coagulation factor transfusion have been widely evaluated in trauma-induced coagulopathy management during the acute post-injury phase. However, the efficacy of red blood cell transfusion has not been adequately investigated in patients with severe trauma, and the optimal hemoglobin target level during the acute post-injury and resuscitation phases remains unclear. Therefore, this study aimed to examine whether a restrictive transfusion strategy was clinically non-inferior to a liberal transfusion strategy during the acute post-injury phase.
methodsThis cluster-randomized, crossover, non-inferiority multicenter trial was conducted at 22 tertiary emergency medical institutions in Japan and included adult patients with severe trauma at risk of major bleeding. The institutions were allocated a restrictive or liberal transfusion strategy (target hemoglobin levels: 7-9 or 10-12 g/dL, respectively). The strategies were applied to patients immediately after arrival at the emergency department. The primary outcome was 28-day survival after arrival at the emergency department. Secondary outcomes included transfusion volume, complication rates, and event-free days. The non-inferiority margin was set at 3%.
resultsThe 28-day survival rates of patients in the restrictive (n = 216) and liberal (n = 195) strategy groups were 92.1% and 91.3%, respectively. The adjusted odds ratio for 28-day survival in the restrictive versus liberal strategy group was 1.02 (95% confidence interval: 0.49-2.13). Significant non-inferiority was not observed. Transfusion volumes and hemoglobin levels were lower in the restrictive strategy group than in the liberal strategy group. No between-group differences were noted in complication rates or event-free days.
conclusionsAlthough non-inferiority of the restrictive versus liberal transfusion strategy for 28-day survival was not statistically significant, the mortality and complication rates were similar between the groups. The restrictive transfusion strategy results in a lower transfusion volume. TRIAL REGISTRATION NUMBER: umin.ac.jp/ctr: UMIN000034405, registration date: 8 October 2018.
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