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Randomized Controlled Trial
. 2019 Mar 1;184(Suppl 1):11-15.
doi: 10.1093/milmed/usy279.

Restrictive Transfusion Strategy Is More Effective in Massive Burns: Results of the TRIBE Multicenter Prospective Randomized Trial

Tina L Palmieri  1 , James H Holmes  2 , Brett Arnoldo  3 , Michael Peck  4 , Amalia Cochran  5 , Booker T King  6 , William Dominic  7 , Robert Cartotto  8 , Dhaval Bhavsar  9 , Edward Tredget  10 , Francois Stapelberg  11 , David Mozingo  12 , Bruce Friedman  13 , Soman Sen  1 , Sandra L Taylor  14 , Brad H Pollock  14
Affiliations
Randomized Controlled Trial

Restrictive Transfusion Strategy Is More Effective in Massive Burns: Results of the TRIBE Multicenter Prospective Randomized Trial

Tina L Palmieri et al. Mil Med. .

Abstract

Objectives: Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: compare outcomes between massive burn (≥60% total body surface area (TBSA) burn) and major (20-59% TBSA) burn using a restrictive or a liberal blood transfusion strategy.

Methods: Patients with burns ≥20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin <7 g/dL) or liberal (transfuse hemoglobin <10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes.

Results: Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 ± 47.63 vs. 77.16 ± 55.0, p < 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p < 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p < 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20-59%) group (p > 0.05).

Conclusions: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.

Keywords: blood transfusion; burn treatment; infection; outcomes.

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