Original ArticleTransfusion Interventions in Critical Bleeding Requiring Massive Transfusion: A Systematic Review
Section snippets
Methods
A study protocol was developed that outlined the participants, interventions, comparators, and outcomes of interest, inclusion and exclusion criteria, and search strategy as outlined below.
Results
The original literature search identified 3050 citations, and a further 49 were included after updating the search as described in the methods section, resulting in a total of 3094 citations. After initial screening, 69 full text articles were selected and reviewed. Of these, 50 were excluded for the following reasons: the primary intervention or outcome was not relevant; the study's patient population did not meet the inclusion criteria; the study was not an SR or RCT; and, the SR only
Discussion
In the previously published Australian PBM guidelines for CB and MT, few recommendations could be made on the use of RBC and blood components due to the lack of high-quality evidence [1]. Although some additional studies were identified in this current review, particularly on the use of RBC in GI hemorrhage, overall little new evidence was found on transfusion interventions that could be used to update previous recommendations or inform practice.
Conclusion
This updated review of CB requiring MT identified 19 new studies (6 RCTs and 13 SRs) addressing 4 main transfusion interventions. These studies provided limited new evidence that can be used to inform practice in this area and substantial evidence gaps remain, particularly with regard to the effect of component therapies, including ratio of RBC to component therapies, on patient outcomes. Clinical trials to address these questions are required.
Conflict of Interest
Zoe McQuilten and Erica Wood are employed by Monash University, whose Transfusion Research Unit has received financial support from Alexion, Amgen, Bayer, Celgene, CSL Behring, Janssen-Cilag, Takeda, Novartis, Australian Red Cross Blood Service, New Zealand Blood Service, Department of Health Victoria (Australia), NBA (Australia) and Myeloma Foundation of Australia. None of these funding sources had any involvement the design or conduct of this review.
Acknowledgments
We thank Jennifer Roberts from the NBA and the authors of the NBA Patient Blood Management Guidelines: Module 1—Critical Bleeding/Massive Transfusion. We thank Dr Carolyn Doree, Information Specialist, NHS Blood and Transplant Systematic Reviews Initiative, for assistance with the literature search. ZM received funding support from the Australian NHMRC Centre of Research Excellence for Patient Blood Management in Critical Illness and Trauma (APP1049071).
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