European Transfusion Practice and Outcome Study (ETPOS)

• ClinicalTrials.gov Identifier: NCT01604083
• Recruitment Status: Completed
• First Posted: May 23, 2012
• Last Update Posted: May 1, 2019
• Sponsor: European Society of Anaesthesiology
• Information provided by (Responsible Party): European Society of Anaesthesiology

Study Description

Brief Summary:

The aim of the ETPOS study is to describe differences in transfusion habits throughout Europe and to correlate these habits to perioperative outcome parameters. Special focus is put on the number of PRBCs (packed red blood cells) transfused and the ratio of PRBCs to other blood products or coagulation factors in the operating room. Furthermore the motivation of physicians to transfuse PRBC and blood products in the operating room will be investigated.

Condition or disease
Surgery; Erythrocyte Transfusion; Habits; Anemia; Blood Coagulation Disorders

Detailed Description:

In European patients undergoing elective non-cardiac surgery receiving at least one PRBC(packed red blood cells) during their surgery it is proposed to:

1. Evaluate evidence of differences in the standard of peri-operative transfusion care in different healthcare systems within Europe, and the use of blood conserving techniques.

   1. Evaluate the ratio of transfusion of PRBC to blood products in the operating room
   2. Evaluate which factors determine transfusion of PRBC (is it patient's haemodynamics / haemoglobin threshold/ pressure from the surgeon / acute brisk bleeding / else) and blood products (ratio to PRBC / POC (point of care) monitoring/ per protocol/ else) in the operating room
2. Evaluate whether there are factors in transfusion therapy that are associated with outcome (in-hospital mortality and unplanned admission to ICU(Intensive Care Unit).)

Study Design

• Study Type: Observational
• Actual Enrollment: 6066 participants
• Observational Model: Cohort
• Time Perspective: Prospective
• Official Title: European Transfusion Practice and Outcome Study A Multi-central Evaluation of Standard of Transfusion Care and Clinical Outcome for Elective Surgical Patients. Observational Study.
• Study Start Date: April 2013
• Actual Primary Completion Date: October 2013
• Actual Study Completion Date: December 2013

Groups and Cohorts

Outcome Measures

Primary Outcome Measures :

1. Amount of PRBC and blood products and coagulation factors transfused [ Time Frame: The Time point at which outcome measure is assessed is during surgery at Day 0 ]
   Amount of packed red blood cells and blood products and coagulation factors: fresh frozen plasmas (FFPs), platelets (PTs) and tranexamic acid transfused

Secondary Outcome Measures :

1. Factors determining transfusion of PRBC and blood products in different regions of Europe [ Time Frame: The Time point at which outcome measure is assessed is during surgery at Day 0 ]
   Reasons for transfusion of PRBC(packed red blood cells)and blood products in different regions of Europe
2. 30-day mortality [ Time Frame: The Time point at which outcome measure is assessed is at Day 30 after Surgery ]
   Assesses on Day 30 whether patient is still alive or has died between day zero (Surgery) day 30 after surgery
3. Unplanned admission to the ICU [ Time Frame: The Time point at which outcome measure is assessed is at Day 30 after Surgery ]
   Assesses on day 30 whether the patient had a Unplanned admission to the Intensive care unit(ICU) following surgery (day 0) until the day 30
4. Type and frequency of usage of blood conserving techniques [ Time Frame: The Time point at which outcome measure is assessed is at Day 0, on Surgery Day ]

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No
• Sampling Method: Non-Probability Sample

Study Population

All patients undergoing a non cardiothoracic, non emergency-trauma surgical procedure of participating hospital will be included, if they receive at least one pRBC. There are no further specific inclusion criteria. The only exclusion criteria will be age < 18 years and cardiothoracic and emergency trauma patients.

Criteria

Inclusion Criteria:

- patients undergoing elective non-cardiac surgery commencing during the three-month period and who received at least one erythrocyte concentrate during their intra-operative stay.

Exclusion Criteria:

• Age < 18 years
• cardiothoracic surgery
• emergency trauma patients

Contacts and Locations

Locations

Croatia

University hospital "Merkur"

Zagreb, Croatia

Czechia

Faculty Hospital Brno

Brno, Czechia

Estonia

North Estonian Center

Tallinn, Estonia

Germany

University Hospital Tübingen University, Germany

Tübingen, Germany

Greece

Aretaieion University Hospital

Athens, Greece

Israel

Tel Aviv Medical Center

Tel Aviv, Israel

Spain

Hospital Vall d Hebron

Barcelona, Spain

Hospital Clínico Universitario de Valencia

Valencia, Spain

Sweden

Sahlgrenska University Hospital

Göteborg, Sweden

Sponsors and Collaborators

European Society of Anaesthesiology

Investigators

• Study Chair: Jens Meier, MD; General Hopsital Linz, Linz, Austria

More Information

Publications of Results:

Meier J, Filipescu D, Kozek-Langenecker S, Llau Pitarch J, Mallett S, Martus P, Matot I; ETPOS collaborators. Intraoperative transfusion practices in Europe. Br J Anaesth. 2016 Feb;116(2):255-61. doi: 10.1093/bja/aev456.

Other Publications:

Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD002042. doi: 10.1002/14651858.CD002042.pub3. Review. Update in: Cochrane Database Syst Rev. 2016 Oct 12;10 :CD002042.

Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ. The CRIT Study: Anemia and blood transfusion in the critically ill--current clinical practice in the United States. Crit Care Med. 2004 Jan;32(1):39-52.

Gombotz H, Rehak PH, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark study. Transfusion. 2007 Aug;47(8):1468-80.

Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, Fukushima J, Kalil Filho R, Sierra DB, Lopes NH, Mauad T, Roquim AC, Sundin MR, Leão WC, Almeida JP, Pomerantzeff PM, Dallan LO, Jatene FB, Stolf NA, Auler JO Jr. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010 Oct 13;304(14):1559-67. doi: 10.1001/jama.2010.1446.

Hsieh FY, Bloch DA, Larsen MD. A simple method of sample size calculation for linear and logistic regression. Stat Med. 1998 Jul 30;17(14):1623-34.

Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999 Feb 11;340(6):409-17. Erratum in: N Engl J Med 1999 Apr 1;340(13):1056.

Johansson PI, Bochsen L, Stensballe J, Secher NH. Transfusion packages for massively bleeding patients: the effect on clot formation and stability as evaluated by Thrombelastograph (TEG). Transfus Apher Sci. 2008 Aug;39(1):3-8. doi: 10.1016/j.transci.2008.05.012. Epub 2008 Jun 25.

Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008 Sep;36(9):2667-74. doi: 10.1097/CCM.0b013e3181844677. Review. Erratum in: Crit Care Med. 2008 Nov;36(11):3134.

Netzer G, Liu X, Harris AD, Edelman BB, Hess JR, Shanholtz C, Murphy DJ, Terrin ML. Transfusion practice in the intensive care unit: a 10-year analysis. Transfusion. 2010 Oct;50(10):2125-34. doi: 10.1111/j.1537-2995.2010.02721.x.

Phan HH, Wisner DH. Should we increase the ratio of plasma/platelets to red blood cells in massive transfusion: what is the evidence? Vox Sang. 2010 Apr;98(3 Pt 2):395-402. Review.

Slonim AD, Joseph JG, Turenne WM, Sharangpani A, Luban NL. Blood transfusions in children: a multi-institutional analysis of practices and complications. Transfusion. 2008 Jan;48(1):73-80. Epub 2007 Sep 24.

Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellmann A, Nollet G, Peres-Bota D; ABC (Anemia and Blood Transfusion in Critical Care) Investigators. Anemia and blood transfusion in critically ill patients. JAMA. 2002 Sep 25;288(12):1499-507.

Zink KA, Sambasivan CN, Holcomb JB, Chisholm G, Schreiber MA. A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study. Am J Surg. 2009 May;197(5):565-70; discussion 570. doi: 10.1016/j.amjsurg.2008.12.014.

Meier J, Kozek-Langenecker S, Filipescu D, Pitarch JV, Mallett S, Martus P, Matot I. ESA Clinical Trials Network 2012: ETPOS--European Transfusion Practice and Outcome Study. Eur J Anaesthesiol. 2013 May;30(5):199-201. doi: 10.1097/EJA.0b013e32835f0052.

• Responsible Party: European Society of Anaesthesiology
• ClinicalTrials.gov Identifier: NCT01604083
• Other Study ID Numbers: ETPOS
• First Posted: May 23, 2012
• Last Update Posted: May 1, 2019
• Last Verified: April 2016

Keywords provided by European Society of Anaesthesiology:

transfusion; packed red blood cells (PRBC); Transfusion Practice; Transfusion habits; Outcome; elective surgery; ETPOS; ESA; European Society of Anaesthesiology

Additional relevant MeSH terms:

Hemostatic Disorders; Blood Coagulation Disorders; Hematologic Diseases; Vascular Diseases; Cardiovascular Diseases; Hemorrhagic Disorders