Reducing by half the typical amount of blood provided through transfusions to burn patients makes no difference in terms of patient outcomes, a new multi-center study led by UC Davis researchers shows.
Blood transfusions help maintain oxygen levels, reduce anemia, support tissue healing and preserve organ function in burn patients. How much blood to use has been controversial, especially because of transfusion-related risks such as infection, lung injury, fluid overload and clotting disorders.
The study — presented at the American Surgical Association meeting held April 20 to 22 in Philadelphia — is the first to define evidence-based best practices when using blood transfusions to treat burn patients.
"The general thinking among burn specialists has been that more is better when it comes to blood transfusions,” said Tina Palmieri, director of the Firefighters Burn Institute Regional Burn Center at UC Davis Medical Center and assistant chief of burn surgery for Shriners Hospitals for Children – Northern California. “We wanted to see if a more restrictive strategy, similar to what is used in other critical-care specialties, made sense for burn patients as well.”
In conducting the study, lead author Palmieri and researchers at more than a dozen burn centers in the U.S., Canada and New Zealand enrolled a total of 345 patients with burns over 20 percent of their bodies. The patients were divided into two groups, with half receiving less blood (a median of eight units) than the other half (a median of 16 units) throughout their hospitalizations, including surgeries.
They found that that bloodstream infections, ventilator days, wound healing, organ problems and mortality were all similar between the two groups, indicating that the restrictive transfusion strategy made better use of blood resources without affecting health outcomes.
Palmieri said the study should help identify standards of care at burn centers worldwide.
"We want to do everything we can to speed the recovery of our patients, but we also don’t want to expose them to treatments they may not need and that may actually cause them harm,” Palmieri said. “Our study provides a great start to defining the most effective and appropriate use of blood transfusions for burn patients.”
Senior authors of the study were Bradley Pollock of UC Davis and David Greenhalgh of UC Davis and Shriners Hospitals for Children – Northern California. Study co-authors were James Holmes of Wake Forest Baptist Health in Winston-Salem, Brett Arnoldo of University of Texas Southwestern Medical Center in Dallas, Michael Peck of Maricopa Medical Center in Phoenix, Bruce Potenza of UC San Diego, Amalia Cochran of the University of Utah in Salt Lake City, Booker King of the Institute of Surgical Research in San Antonio, William Dominic of Community Regional Medical Center in Fresno, Robert Carlotto of Sunnybrook Health Sciences Center in Toronto, Dhaval Havsar of Kansas University Medical Center, Nathan Kemalayan of Oregon Burn Center in Portland, Edward Tredget of the University of Alberta in Edmonton, Francois Stapelberg of New Zealand National Burn Centre in Middlemore and David Mozingo of University of Florida Health Science Center in Gainesville.
The study was funded by the U.S. Army Medical Research and Material Command (grant W81XWH0810760), the National Center for Research Resources of the National Institutes of Health (grant UL1RR024146) and the National Center for Advancing Translational Sciences of the National Institutes of Health (grant TR000002).
A Center of Excellence, the Firefighters Burn Institute Regional Burn Center unites the exceptional surgical, critical care and rehabilitation resources of UC Davis to care for the unique needs of adult burn patients. The team also treats pediatric burn patients through a partnership with Shriners Hospitals for Children – Northern California. In addition to a comprehensive clinical program, the burn center conducts research aimed at improving patient outcomes, leads community outreach to support burn survivors and provides education to reduce burn injuries. More information is at www.ucdmc.ucdavis.edu/burncenter/