RCT

HEMOTION

Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury

NEJM, 2024 · Multicenter randomized trial (n=742)

Clinical question

Does a liberal RBC threshold improve neurologic outcome after moderate or severe traumatic brain injury?

Population: Critically ill adults with moderate or severe traumatic brain injury and anemia
Intervention: Liberal transfusion threshold approximately Hb <=10 g/dL
Comparator: Restrictive threshold approximately Hb <=7 g/dL
Primary outcome: Unfavorable neurologic outcome at 6 months
Result: Unfavorable neurologic outcome was numerically lower with the liberal strategy (68.4% vs 73.5%), but the primary comparison was not statistically significant; mortality was similar.

What the trial found

A liberal strategy did not significantly improve the primary neurologic outcome.

Current guideline position

Important neurocritical-care transfusion evidence; no universal Hb 10 g/dL mandate.

Clinical interpretation

TBI transfusion should not be reduced to a single general-ICU threshold; integrate cerebral physiology, bleeding, ischemia and trial uncertainty.

Clinical Context & Relevant Topics (2)

Disease Reference

Blood Product Transfusion in Critical Care

Patient-specific RBC transfusion thresholds, current platelet/procedural thresholds, plasma/cryoprecipitate use, and the TRALI vs TACO diagnostic matrix.

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Severe Traumatic Brain Injury

Severe TBI neurocritical care: prevent hypoxemia/hypotension, treat intracranial hypertension, individualize ventilation/CPP, use evidence-based short antiseizure prophylaxis when chosen, and escalate surgery when indicated.

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