While a restrictive RBC transfusion strategy has been shown to be safe and effective for most patients, there is uncertainty about the best strategy for critically ill patients with traumatic brain injury (TBI). These patients may require increased oxygen delivery for long-term neurological function. The international Hemoglobin (Hb) Transfusion Threshold in Traumatic Brain Injury Optimization (HEMOTION) trial was designed to compare a liberal (Hb threshold of <10 g/dL) versus restrictive (Hb threshold of <7 g/dL) transfusion strategy on mortality and functional outcomes in patients with TBI. Briefly, 742 adult patients (73% male; median age, 49 years) with moderate to severe TBI and anemia (Hb <10 g/dL) were randomized 1:1 to receive RBCs based on a liberal or restrictive strategy. Overall, 99% and 38% of the patients in the liberal and restrictive study arms, respectively, received at least one transfusion. The primary outcome at six months—based on the Glasgow Coma Scale Outcome-Extended functional scale—was not statistically different for the patients in the liberal vs. restrictive arms; unfavorable outcomes occurred in 68% (249/364) and 74% (263/358) of patients in the liberal and restrictive arms, respectively (adjusted absolute difference 5.4 percentage points; 95% CI, -2.9 to 13.7). A liberal transfusion strategy did not statistically reduce the risk of unfavorable neurological outcomes or mortality in patients with TBI and anemia, but further studies on the impact of quality of life may be needed.
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