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HEMOglobin transfusion threshold in Traumatic brain Injury OptimizatioN: The HEMOTION TRIAL

Funding: Canadian Institutes of Health Research (CIHR)
Status: Recruiting

PIs: Alexis F. Turgeon, Dean Fergusson, François Lauzier

Co-Is: Lynne Moore, Almunder Algird, Andrew Baker, Ian Ball, Karen Burns, Emmanuel Charbonney, Michaël Chassé, Shane English, Robert Green, Donald Griesdale, Paule Lessard-Bonaventure, Andreas Kramer, François Lamontagne, Vincent Laroche, Damon Scales, Jason Shahin, Maude St-Onge, Alan Tinmouth, Ryan Zarychanski, David Zygun, Alison Fox-Robichaud

Transfusion practices in the overall medical/surgical critical care population of patients have been extensively studied, but data pertaining specifically to critically ill brain-injured patients remain scarce as traumatic brain injury (TBI) patients were excluded or underrepresented in previous studies focused on transfusion practices. However, most critically ill patients with a TBI will develop anemia during their hospital stay, resulting in lower levels of hemoglobin which is responsible for oxygen delivery to tissues. This may result in a decrease in oxygen delivery to end organs, and more so to a fragile, traumatized brain.

Indeed, due to the vulnerability of the brain to secondary insults, concerns have been expressed toward restrictive transfusion strategies (transfusion threshold at low hemoglobin levels) in patients with TBI. The administration of RBC transfusions to maintain higher hemoglobin levels and increase cerebral oxygen delivery are advocated by some experts.

To date, no consensus has been reached on an appropriate transfusion threshold in this specific critical care population as evidence-based driven data is clearly lacking. We developed a research program to establish the optimal transfusion strategy in patients with TBI. Our findings will lead to a better understanding of the brain’s blood requirements in this vulnerable population as well as a change in current transfusion practices, ensuring optimal usage of a scarce resource.

Canadian sites:

CHU de Québec – Université Laval (Hôpital de l’Enfant-Jésus, Québec city, Québec)

CIUSSS de l’Estrie – Centre Hospitalier Universitaire de Sherbrooke (Hôpital Fleurimont, Sherbrooke, Québec)

McGill University Health Centre (Montréal General Hospital (Montréal, Québec))

The Ottawa Hospital (Civic Campus, Ottawa, Ontario)

Sunnybrook Health Sciences Centre (Toronto, Ontario)

St-Michael’s Hospital (Toronto, Ontario)

Hamilton Health Sciences Center (Hamilton, Ontario)

London Health Sciences Center (London, Ontario)

CIUSS de la Mauricie-et-Centre-du-Québec (Centre Hospitalier Régional de Trois-Rivières, Québec)

Winnipeg Health Sciences Center (Winnipeg, Manitoba)

Foothills Health Sciences Center (Calgary, Alberta)

Royal Alexandra Hospital (Edmonton, Alberta)

University of Alberta Hospital (Edmonton, Alberta)

Vancouver General Hospital (Vancouver, British Columbia)

Queen Elizabeth II Health Sciences Center (Halifax, Nova Scotia)

Kingston General Hospital (Kingston, Ontario)

Vancouver Island Health Authority (Royal Jubilee Hospital, Victoria, British Colombia)

 

UK sites: 

Western General Hospital, Edinburgh

James Cook Hospital, Middlesbrough

St Mary’s Hospital, London

Salford Royal Hospital, Salford

The University of Nottingham Hospital, Nottingham

King’s College Hospital, London

University Hospital of Wales, Cardiff

For more information go to clinicaltrials.gov

For more information go to www.hemotion.ca

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