Age of red cells for transfusion and outcomes in critically ill adults

D. James Cooper, Zoe K. McQuilten, Alistair Nichol, Bridget Ady, Cecile Aubron, Michael Bailey, Rinaldo Bellomo, Dashiell Gantner, David O. Irving, Kirsi-Maija Kaukonen, Colin McArthur, Lynne Murray, Ville Pettila, Craig French

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BACKGROUND: It is uncertain whether the duration of red-cell storage affects mortality after transfusion among critically ill adults. METHODS: In an international, multicenter, randomized, double-blind trial, we assigned critically ill adults to receive either the freshest available, compatible, allogeneic red cells (short-term storage group) or standard-issue (oldest available), compatible, allogeneic red cells (long-term storage group). The primary outcome was 90-day mortality. RESULTS: From November 2012 through December 2016, at 59 centers in five countries, 4994 patients underwent randomization and 4919 (98.5%) were included in the primary analysis. Among the 2457 patients in the short-term storage group, the mean storage duration was 11.8 days. Among the 2462 patients in the long-term storage group, the mean storage duration was 22.4 days. At 90 days, there were 610 deaths (24.8%) in the short-term storage group and 594 (24.1%) in the long-term storage group (absolute risk difference, 0.7 percentage points; 95% confidence interval [CI], -1.7 to 3.1; P = 0.57). At 180 days, the absolute risk difference was 0.4 percentage points (95% CI, -2.1 to 3.0; P = 0.75). Most of the prespecified secondary measures showed no significant between-group differences in outcome. CONCLUSIONS: The age of transfused red cells did not affect 90-day mortality among critically ill adults.

Original languageEnglish
Pages (from-to)1858-1867
Number of pages10
JournalThe New England Journal of Medicine
Issue number19
Publication statusPublished - 9 Nov 2017


  • blood, transfusion, red blood cells, fresh. red-cell storage, clinical trial

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