Influence of multiple trauma on the effect of transfusion strategies in patients with traumatic brain injury: a sub-study of the HEMOTION trial.
| Title: | Influence of multiple trauma on the effect of transfusion strategies in patients with traumatic brain injury: a sub-study of the HEMOTION trial. |
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| Authors: | Bouras M; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada.; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Canada.; Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Régional Universitaire de Brest, Brest, France.; Lauzier F; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada.; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Canada.; Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada.; Fergusson DA; Ottawa Hospital Research Institute, Ottawa, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Neveu X; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada.; Clayton L; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada.; Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Canada.; Patton MP; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada.; Costerousse O; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada.; English SW; Ottawa Hospital Research Institute, Ottawa, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Docherty A; Usher Institute of Population Health Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.; Department of Anaesthesia, Critical Care and Pain Medicine, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.; Malbouisson LMS; Surgical Intensive Care Unit, Anesthesiology Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.; Zarychanski R; Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.; Department of Medical Oncology/Haematology, The Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, Canada.; Moore L; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Canada.; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada.; Lessard Bonaventure P; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Canada.; Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Université Laval, Quebec City, Canada.; Laroche V; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada.; Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada.; Verret M; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada.; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Canada.; Scales DC; Department of Critical Care Medicine, Sunnybrook Health Sciences Center and Sunnybrook Research Institute, Toronto, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Adhikari NKJ; Department of Critical Care Medicine, Sunnybrook Health Sciences Center and Sunnybrook Research Institute, Toronto, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Greenbaum J; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.; Kramer A; Departments of Critical Care Medicine and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.; Garnelo Rey V; St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.; Ball I; Department of Medicine and Department of Epidemiology and Biostatistics, Western University, London, Canada.; Khwaja K; Departments of Surgery and Critical Care Medicine, McGill University Health Centre, Montreal, Canada.; Wise M; Cardiff University, Cardiff, UK.; University of Wales Hospital, Cardiff, UK.; Harvey D; Nottingham University Hospitals NHS Trust, Nottingham, UK.; Chabanne R; Département Anesthésie Réanimation Et Médecine Périopératoire, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Clermont-Ferrand, France.; Pottecher J; Hôpital de Hautepierre, Service d'Anesthésie-Réanimation Et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.; Rhodes J; Usher Institute of Population Health Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.; Rigamonti A; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Canada.; Burns KEA; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto, Canada.; Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.; Department of Critical Care, Unity Health Toronto-St. Michael's Hospital, Toronto, Canada.; Griesdale DE; Department of Medicine, Division of Critical Care Medicine, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.; Kutsogiannis DJ; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.; Green R; Trauma Nova Scotia, Nova Scotia Health, Halifax, Canada.; Departments of Critical Care, Emergency Medicine, Anesthesia and Surgery, Dalhousie University, Halifax, Canada.; Boyd JG; Department of Medicine, Division of Neurology, School of Medicine, Queen's University, Kingston, Canada.; Department of Critical Care Medicine, School of Medicine, Queen's University, Kingston, Canada.; Zeiler F; Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, Canada.; Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.; Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.; Gomez A; Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.; Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.; Charbonney E; Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.; Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.; Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada.; Astles T; Department of Intensive Care Medicine, Liverpool University Hospitals NHS, Liverpool, UK.; Sy E; College of Medicine, University of Saskatchewan, Regina, Canada.; Saskatchewan Health Authority-Regina Area, Regina, Canada.; Turgeon AF; Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada. alexis.turgeon@crchudequebec.ulaval.ca.; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Canada. alexis.turgeon@crchudequebec.ulaval.ca. |
| Corporate Authors: | HEMOTION Trial investigators, the Canadian Critical Care Trials Group, the Canadian Perioperative Anesthesia Clinical Trials Group, the Canadian Traumatic Brain Injury Research Consortium |
| Source: | Intensive care medicine [Intensive Care Med] 2026 Feb; Vol. 52 (2), pp. 211-229. Date of Electronic Publication: 2026 Mar 03. |
| Publication Type: | Journal Article; Randomized Controlled Trial |
| Language: | English |
| Journal Info: | Publisher: Springer Verlag Country of Publication: United States NLM ID: 7704851 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1238 (Electronic) Linking ISSN: 03424642 NLM ISO Abbreviation: Intensive Care Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: New York : Springer Verlag; Original Publication: Berlin ; New York, Springer International. |
| MeSH Terms: | Brain Injuries, Traumatic*/complications ; Brain Injuries, Traumatic*/therapy ; Brain Injuries, Traumatic*/mortality ; Blood Transfusion*/methods ; Blood Transfusion*/statistics & numerical data ; Multiple Trauma*/complications ; Multiple Trauma*/mortality ; Multiple Trauma*/therapy; Anemia/therapy ; Anemia/etiology ; Humans ; Male ; Female ; Adult ; Middle Aged ; Quality of Life ; Injury Severity Score ; Glasgow Outcome Scale ; Aged |
| Abstract: | Purpose: In moderate-to-severe traumatic brain injury (TBI), anemia may exacerbate secondary cerebral injury, and patients with multiple trauma may be especially vulnerable to cerebral hypoxia. We conducted a secondary analysis of the HEMOTION trial (liberal transfusion strategy > 10 g/dL vs. restrictive > 7 g/dL), to assess whether multiple trauma modifies the effect of transfusion strategy after moderate-to-severe TBI.; Methods: We included all HEMOTION trial participants (n = 742) and defined multiple trauma using three definitions: (1) extracranial injury with Injury Severity Score (ISS) > 15; (2) extracranial injury requiring emergency extracranial surgery; (3) spinal injury with neurological deficit. The primary outcome was the 6-month Glasgow Outcome Scale Extended (GOS-E). We tested interactions between transfusion strategy and multiple trauma status using sliding dichotomy and hierarchical Poisson regression, with sensitivity analyses using classical dichotomy (GOS-E ≤ 4) and proportional odds models. Secondary outcomes included mortality, quality of life (EQ-5D-5L, QOLIBRI), functional independence (FIM), and depression (PHQ-9).; Results: We found no interaction between multiple trauma status and transfusion strategies on the 6-month GOS-E across all three definitions. The adjusted relative risk (RR) of an unfavourable outcome with the liberal strategy was 0.87 (95% CI 0.71-1.07) for patients with ISS > 15, 0.79 (0.59-1.05) for emergency extracranial surgery, and 0.99 (0.42-2.33) for spinal cord injury. Sensitivity analyses suggested a potential interaction for patients undergoing emergency extracranial surgery (p-interaction = 0.02 for proportional odds analysis; 0.05 for classical dichotomy). A liberal strategy was associated with better FIM, EQ-5D-5L, and Qolibri scores for definitions 1 and 2, but not 3, with no consistent interaction. Mortality and PHQ-9 did not differ.; Conclusion: Multiple trauma status was not associated with the effect of liberal vs. restrictive transfusion strategies on the GOS-E. Patients requiring emergency extracranial surgery may warrant further investigation.; (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Conflicts of interest: Dr. Chabanne reports receiving consulting fees from Sophysa, LXO ans Cormedica Neuromedex. Dr. Pottecher reports receiving consulting fees from Masimo, LFB Biomedicaments, and Octapharma. Dr. Boyd reports receiving an in-kind donation of cerebral oximeters from Edwards Life Sciences for his research program. Dr English and Dr Docherty declare academic grants. All authors have completed and submitted the ICMJE disclosure form. No potential conflicts of interest relevant to this article were reported for the other authors. Ethical approval: The HEMOTION trial protocol was approved by the research ethics board at the Centre Hospitalier Universitaire de Québec-Université Laval and at all participating centers. A priori or deferred informed consent was obtained from surrogate decision makers for each participant. Consent was later obtained from patients if they regained capacity. |
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| Contributed Indexing: | Investigator: D Bellemare; MC Boulanger; É Brassard; È Cloutier; O Costerousse; L Côté; É Couillard-Chénard; R Daher; M Daigle; C Delisle-Thibault; C Francoeur; S Grenier; G Guilbault; CJ Isaac; L Labbé; V Laroche; F Lauzier; G LeBlanc; C Léger; P Lessard Bonaventure; LC Mallard; B Marandyuk; S Massana; S Nadeau-Caplette; I St-Hilaire; M St-Onge; A Tremblay; MC Tremblay; A Turgeon; M Verret; MÈ Caron; L Durocher; J Loranger; JF Naud; É Rodrigue; D Tapps; JN Dubé; J Belisle; MP Bouchard; E Carbonneau; L Côté; F D'Aragon; I D'Hervé; J Grégoire; M Ladouceur; J Marchand; MH Masse; D Pellerin; Y Poulin; H Quiroz; C St-Arnaud; F Lamontagne; N Alam; J Campisi; D Deckelbaum; J Grushka; A Gursahaney; D Hornstein; D Jayaraman; L Mian; A Kaur; R Rahgoshai; R Rahgoshai; T Razek; R Salisidis; J Shahin; P Zanelli; K Khwaja; F Benettaib; D Boumahni; K Coutu-Beadry; A Ghamraoui; M Gagnon-Hamelin; F Lamothe; M Lebrasseur; C Prie; M Salame; M Chassé; A Aimable-Brathwaite; R Cloutier; M Cummings; D Fergusson; B Gomes; J Haines; L Leclair; R Porteous; K Steeves; A Tuttle; A Van Beinum; I Watpool; J Xin; S English; K Jeganathan; D Jichici; A Martyniuk; M Meade; S Sharma; A Algrid; E Campbell; R Rondinelli; L Winters; I Zaborovskaya; I Ball; T Boyd; I Georgescu; M Hanley; M Hunt; G Boyd; A Baker; K Burns; E Churcher; J Hodder; I Khalid; J Marshall; G Sandhu; M Santos; A Rigamonti; NKJ Adhikari; M Chapman; C Colavecchia; B Cuthbertson; R Fowler; M Kamra; H Khan; N Marinoff; T Sabananthan; T Sugumaran; D Scales; D Foster; N Garraway; R Grey; MS Sekhon; DE Griesdale; F Auld; C Casault; J Craighead; G Garney; D Ovakim; D Parfett; G Wood; S Alias; S Browne; G Vazquez-Grande; A Gomez; J Lys; N Marten; D Muhammad; M Wilson; F Zeiler; R Zarychanski; C Codan; P Couillard; O Dmitrieva; L Guan; L Hagan; L Hiar; J Kromm; A Lee; K Makuk; LA Ortiz; J Reyes; S Rudell; A Kramer; T Hewer; M Jacka; A Parker; P Thompson; DJ Kutsogiannis; V Barrette; M Erdogan; D Gillis; O Loubani; L Magennis; E Tan; R Green; J England; C Gupta; J Lee; J Mailman; S Kassir; E Sy; P Andrews; M Amamio; L Barclay; S Birch; K Briton; S Clark; K Doverman; J Emelifeonwu; D Hope; J Singleton; L Marshall; S Simpson; N Rea; C McCulloch; J Rhodes; T Walsh; H Gagiano; J Jones; J Morley; E Headlam; K Hugill; L Simpson; A Thompson; J Wright; N Athanasios; A Baddeley; A Baidoo; A Clark; L Conner; M Dent; S Finucane; D Ford; A Gibbins; T Joseph; M Langley; S Maitland; L McLoughlin; M Meredith; L Morris; C Peters; N Plummer; L Ryan; J Sampson; D Spîck; J Haghi Theerata; A Thomas; C Walton; D Harvey; S Barber; B Barratt; N Butterworth; L Catlow; K Cawley; B Charles; J Dearden; R Doonan; L Harrison; D Kay; S Lee; D Lomas; C Lyons; D McLaughlan; A Vian-Michael; D Morris; J Pendlebury; J Perez; N Shahedy; M Slaughter; A Sukumaran; L Swindells; J Greenbaum; J Brooks; J Cheung; J Cole; J Curtin; M Davies; R Davies; L Hunt; H Hill; A Nawaz; E Thomas; A Williams; M Wise; Z Fernandez de Pinedo Artaraz; D Banach; P Coghlan; A Tamang Gurung; E Jepson; A Mohammed; R Rojo; S Sousa Arias; M Templeton; J Wong; V Garnelo Rey; L Bailey; O Bani-Saad; M Chikungwa; F Clark; N Coleman; M Davies; I Elsayed; M Gellamucho; J Hidden; S Lord; M Marsden; R Matsa; N Patel; F Rodriguez-Albarran; E Sernicola; C Thompson; S Krueper; I Turner-Bone; A Reddy; L Wilding; T Astles; J Broad; J Cater; V Empson; C Fletcher; J Gordon; S Gwatikunda; M Jennings; J McGregor; S Nicholls; V Paulsen; R Russel; G Smith; K Walker; G Williams; P Nair; Y Brunin; L Carteron; C Despres; E Genestier; M Ginet; D Ilic; S Paillot; PA Poinsot; L Vettoretti; S Pili-Floury; J Amat; É Caumon; L Chiodetti; A Masgrau; PA Pioche; B Rieu; C Rolhion; R Chabanne; G Arfeuille; B Bouchier; S Hecketsweiler; F Planquart; A Romoli; H Tayebi; TN Chamaraux-Tran; A Meyer; M Szczot; J Pottecher; A Ambert; L Elotmani; S Lloret; L Muller; JY Lefrant; C Roger; F Agena; V Henriques Do Amaral; AP Carvalho Canela Balzi; C Oliveira; W Paiva; F Aliotti Regalio; R Figueiredo Vieira Bento; LM Sá Malbouisson; C Amendola; T Andrade; J Borges; B Costa Duarte da Conceição; F Rodrigues Da Silva; L Pierini de Almeida; J Oliveira de Jesus; I Ferrari Del Favero; CC Giardi; LC Dias Lourenço; NA Reis Carneiro; L Silva Sisconetto; L Clayton; MP Patton; L Moore; M Verret; A Docherty; G Cranswick; D Alexander; G Beveridge; S Begg; J Coyle; A Giddings; G Innes; M Steven; S Depierre; M Simon; M Simon; DJ Triulzi; J Cook; C Hemphill; Keywords: Anemia; Extracranial surgery; Glasgow outcome scale extended; Multiple trauma; Transfusion strategy; Traumatic brain injury |
| Entry Date(s): | Date Created: 20260303 Date Completed: 20260309 Latest Revision: 20260513 |
| Update Code: | 20260514 |
| PubMed Central ID: | PMC12971814 |
| DOI: | 10.1007/s00134-025-08290-5 |
| PMID: | 41774107 |
| Database: | MEDLINE |
Journal Article; Randomized Controlled Trial