Standard Issue Transfusion Versus Fresher Red Blood Cell Use in Intensive Care- A Randomised Controlled Trial

NCT ID: NCT01638416

Last Updated: 2020-10-22

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

4994 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-10-31

Study Completion Date

2017-06-30

Brief Summary

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In Australia, blood for transfusion has a "use by" date of 42 days after collection. The actual age of blood given to patients depends on what is available at the time and the rate of usage. During the last decade, it has been reported that blood transfusion in patients admitted to intensive care was associated with an independent increase of mortality. Some research suggests that transfusion of fresher blood might help patients in the intensive care unit to reach a better recovery. This project will test whether patients who receive 'fresher' blood do better than patients who receive 'standard issue' blood.

Detailed Description

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Inclusion criteria

•Patients hospitalised in ICU with an anticipated ICU stay of at least 24 hours, in whom the decision has been made by medical staff to transfuse at least one RBC unit.

Exclusion criteria

* Age younger than 18
* Previous RBC transfusion during the current hospital admission (including transfusion in another hospital for transferred patients)
* Diagnosis of transplantation or hematologic diseases
* Pregnancy
* Cardiac surgery during the present hospital admission
* Expected to die imminently (\<24hrs)
* The treating physician believes it is not in the best interest of the patient to be randomised in this trial.
* Known objection to the administration of human blood products
* Participation in a competing study

Primary outcome- 90 day mortality

Secondary outcomes

1. 28 day mortality
2. Persistent Organ Dysfunction combined with death at 28
3. Days alive and free of mechanical ventilation at day 90 post randomisation
4. Day alive and free of renal replacement therapy at day 90 post randomisation
5. Blood stream infection in ICU (post randomisation) defined using the Center for Disease Control and Prevention/National Healthcare Safety Network criteria
6. Length of stay in ICU and in hospital post randomisation
7. Febrile non-haemolytic transfusion reactions
8. EQ-5D score at Day 90 post randomisation

Conditions

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Transfusion Age of Blood

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Two staff not involved in the direct care of each patient checked the red-cell units, and concealed the collection and expiry dates from clinical staff using a bag with opaque panels (Australia, Ireland and Saudi Arabia), or an obscuring sticker (NZ and Finland).

Study Groups

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Standard of care

Blood Transfusion Standard of care- oldest blood.

Group Type ACTIVE_COMPARATOR

Blood transfusion

Intervention Type OTHER

Blood transfusion in ICU patients aged 18 and over.

Arm B

Blood Transfusion Freshest blood.

Group Type OTHER

Blood transfusion

Intervention Type OTHER

Blood transfusion in ICU patients aged 18 and over.

Interventions

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Blood transfusion

Blood transfusion in ICU patients aged 18 and over.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients hospitalised in ICU with an anticipated ICU stay of at least 24 hours, in whom the decision has been made by medical staff to transfuse at least one RBC unit.

Exclusion Criteria

* Age younger than 18
* Previous RBC transfusion during the current hospital admission (including transfusion in another hospital for transferred patients)
* Diagnosis of transplantation or hematologic diseases
* Pregnancy
* Cardiac surgery during the present hospital admission
* Expected to die imminently (\<24hrs)
* The treating physician believes it is not in the best interest of the patient to be randomised in this trial.
* Known objection to the administration of human blood products
* Participation in a competing study (see below)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Australian Red Cross

OTHER

Sponsor Role collaborator

New Zealand Blood Service

OTHER

Sponsor Role collaborator

Irish Blood Transfusion Service

OTHER

Sponsor Role collaborator

Finnish Red Cross Blood Service

OTHER

Sponsor Role collaborator

King Abdulaziz Medical City

OTHER_GOV

Sponsor Role collaborator

University College Dublin

OTHER

Sponsor Role collaborator

Australian and New Zealand Intensive Care Research Centre

OTHER

Sponsor Role lead

Responsible Party

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David James Cooper

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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D. James Cooper, A.O., M.D.

Role: PRINCIPAL_INVESTIGATOR

Monash University/Alfred Hospital

Locations

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The Alfred Hospital

Melbourne, Victoria, Australia

Site Status

Lyell McEwin Hospital

Adelaide, , Australia

Site Status

Queen Elizabeth Hospital

Adelaide, , Australia

Site Status

Royal Adelaide Hospital

Adelaide, , Australia

Site Status

Albury Hospital

Albury, , Australia

Site Status

Bendigo Hospital

Bendigo, , Australia

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Logan Hospital

Brisbane, , Australia

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Mater Adult Hospital

Brisbane, , Australia

Site Status

Mater Private Hospital

Brisbane, , Australia

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Princess Alexandra Hospital

Brisbane, , Australia

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Royal Brisbane and Women's Hospital

Brisbane, , Australia

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Calvary Health

Canberra, , Australia

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Canberra Hospital

Canberra, , Australia

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Dandenong Hospital

Dandenong, , Australia

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Geelong Hospital

Geelong, , Australia

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Gold Coast Hospital

Gold Coast, , Australia

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Gosford Hospital

Gosford, , Australia

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Austin Hospital

Heidelberg, , Australia

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Royal Hobart Hospital

Hobart, , Australia

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Cabrini Hospital

Melbourne, , Australia

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Frankston Hospital

Melbourne, , Australia

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Knox Private Hospital

Melbourne, , Australia

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Monash Medical Centre

Melbourne, , Australia

Site Status

Northern Hospital

Melbourne, , Australia

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Royal Melbourne Hospital

Melbourne, , Australia

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St Vincent's Hospital

Melbourne, , Australia

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Sunshine Hospital

Melbourne, , Australia

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Western Hospital

Melbourne, , Australia

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Calvary Mater Newcastle

Newcastle, , Australia

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John Hunter Hospital

Newcastle, , Australia

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Fiona Stanley Hospital

Perth, , Australia

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Royal Perth Hospital

Perth, , Australia

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St John of God Murdoch Hospital

Perth, , Australia

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Epworth Hospital

Richmond, , Australia

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Blacktown Hospital

Sydney, , Australia

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Nepean Hospital

Sydney, , Australia

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Prince of Wales Hospital

Sydney, , Australia

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Royal Prince Alfred Hospital

Sydney, , Australia

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St George Hospital

Sydney, , Australia

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St Vincent's Hospital

Sydney, , Australia

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Tamworth Hospital

Tamworth, , Australia

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Wollongong Hospital

Wollongong, , Australia

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Helsinki University Hospital

Helsinki, , Finland

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Tampere University Hospital

Tampere, , Finland

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Cork University Hospital

Cork, , Ireland

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Beaumont Hospital

Dublin, , Ireland

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St James's Hospital

Dublin, , Ireland

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St Vincent's University Hospital

Dublin, , Ireland

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Galway Regional Hospital

Galway, , Ireland

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Limerick Regional Hospital

Limerick, , Ireland

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Auckland City Hospital CVICU

Auckland, , New Zealand

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Auckland City Hospital DCCM

Auckland, , New Zealand

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Middlemore Hospital

Auckland, , New Zealand

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North Shore Hospital

Auckland, , New Zealand

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Christchurch Hospital

Christchurch, , New Zealand

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Dunedin Hospital

Dunedin, , New Zealand

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Waikato Hospital

Hamilton, , New Zealand

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Nelson Hospital

Nelson, , New Zealand

Site Status

Wellington Hospital

Wellington, , New Zealand

Site Status

King Abdulaziz Medical City

Riyadh, , Saudi Arabia

Site Status

Countries

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Australia Finland Ireland New Zealand Saudi Arabia

References

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Radford M, Estcourt LJ, Sirotich E, Pitre T, Britto J, Watson M, Brunskill SJ, Fergusson DA, Doree C, Arnold DM. Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support. Cochrane Database Syst Rev. 2024 May 23;5(5):CD011305. doi: 10.1002/14651858.CD011305.pub3.

Reference Type DERIVED
PMID: 38780066 (View on PubMed)

Cooper DJ, McQuilten ZK, Nichol A, Ady B, Aubron C, Bailey M, Bellomo R, Gantner D, Irving DO, Kaukonen KM, McArthur C, Murray L, Pettila V, French C; TRANSFUSE Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults. N Engl J Med. 2017 Nov 9;377(19):1858-1867. doi: 10.1056/NEJMoa1707572. Epub 2017 Sep 27.

Reference Type DERIVED
PMID: 28952891 (View on PubMed)

Kaukonen KM, Bailey M, Ady B, Aubron C, French C, Gantner D, Irving D, Murray L, Nichol A, Pettila V, McQuilten Z, Cooper DJ. A randomised controlled trial of standard transfusion versus fresher red blood cell use in intensive care (TRANSFUSE): protocol and statistical analysis plan. Crit Care Resusc. 2014 Dec;16(4):255-61.

Reference Type DERIVED
PMID: 25437218 (View on PubMed)

Kekre N, Mallick R, Allan D, Tinmouth A, Tay J. The impact of prolonged storage of red blood cells on cancer survival. PLoS One. 2013 Jul 16;8(7):e68820. doi: 10.1371/journal.pone.0068820. Print 2013.

Reference Type DERIVED
PMID: 23874777 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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ANZICRCDJC006

Identifier Type: -

Identifier Source: org_study_id

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