Abstract
BackgroundAnemia is common in neurocritically ill patients. Considering the limited clinical evidence in this population, preclinical data may provide some understanding of the potential impact of anemia and of red blood cell transfusion in these patients. We aim to estimate the association between different transfusion strategies and neurobehavioral outcome in animal models.MethodsWe will conduct a systematic review of comparative studies of red blood cell transfusion strategies using animal models of traumatic brain injury, ischemic stroke or cerebral hemorrhage. We will search MEDLINE, EMBASE, and Web of Science databases for eligible studies from inception onwards. Two independent reviewers will perform study selection and data extraction. We will report our results in a descriptive synthesis focusing on characteristics of included studies, reported outcomes, risk of bias, and construct validity. Our primary outcome is the neurological function (neurobehavioral performance) and our secondary outcomes include mortality, infarct size, intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and brain tissue oxygen tension. If appropriate, we will also perform a quantitative synthesis and pool results using random-effect models. Heterogeneity will be expressed with I2 statistics. Subgroup analyses are planned according to animal model characteristics, co-interventions, and risks of bias.DiscussionOur study is aligned with the efforts to better understand the level of evidence on the impact of red blood cell transfusion strategies from preclinical studies in animal models of acute brain injury and the potential translation of information from the preclinical to the clinical research field.Systematic review registrationPROSPERO CRD42018086662.
Highlights
Anemia is common in neurocritically ill patients
Eligibility criteria We will include studies using in vivo animal models with acute cerebral lesions limited to traumatic brain injury or stroke comparing outcome in injured animals treated with a specific red blood cell (RBC) transfusion strategy with outcome in injured animals treated with a different RBC transfusion strategy or no treatment or any other intervention
We have developed a strategy for MEDLINE using a combination of keywords related to “anemia,” “red blood cell transfusion,” “traumatic brain injury,” “stroke,” and “intracranial hemorrhage.”
Summary
Considering the limited clinical evidence in this population, preclinical data may provide some understanding of the potential impact of anemia and of red blood cell transfusion in these patients. Anemia is frequently encountered in critically ill patients [1, 2] and red blood cell (RBC) transfusions are often used to correct anemia [1,2,3]. Data on the potential impact of RBC transfusion on mortality and other clinically significant outcomes have been collected from large cohort studies [1, 4, 5]. In the last two decades, multiple observational studies have shown contradictory results when assessing the relation between anemia, RBC transfusion, and clinical outcomes in the neurocritically ill population [16,17,18,19,20]. The few RCTs on RBC transfusion in this specific population were unable to show superiority of any transfusion strategy [9, 21, 22], confirming our inability to formulate recommendations on a specific transfusion strategy for patients with acute brain injury [23]
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