Red blood cell transfusion and mortality effect in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis protocol.
BACKGROUND
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating disease that leads to important morbidity and mortality in a young patient population. Anemia following aSAH is common and may be exacerbated by the treatments instituted by clinicians as part of standard care. The role and optimal thresholds for red blood cell (RBC) transfusion in this patient population remains unknown.


METHODS
We will conduct a systematic review of the literature using MEDLINE, EMBASE, and EBM Reviews (including Cochrane Central databases) using a comprehensive search strategy for observational and interventional studies of RBC transfusion in aSAH. Our primary objective is to evaluate the association of RBC transfusion with mortality in aSAH patients. Secondary objectives include a) determining associations between RBC transfusion and poor neurologic outcome, b) defining an optimal RBC transfusion threshold in aSAH patients, and c) describing complications associated with RBC transfusion in aSAH patients. We plan a descriptive reporting of all included citations including study characteristics, methodological quality, and reported outcomes. Clinical and statistical heterogeneity observed between studies will be described. If appropriate, meta-analyses of suitable studies and interpretation of their results will be performed. Effect measures will be converted to obtain relative risks and odds ratios (RR and ORs) with 95% confidence intervals and pooled according to study design (randomized trials and observational studies respectively) using a random effects model.


CONCLUSIONS
This review will summarize the existing observational and trial evidence regarding RBC transfusion in aSAH patients. The analytical plan has made considerations for different study designs, both observational and interventional in nature, and will summarize the best available evidence to inform the end user and policy and guideline producers and to highlight areas in need of further study.


BACKGROUND
PROSPERO CRD42014014806.
Department of Medicine (Critical Care), The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Rm F202, Ottawa, ON, K1Y 4E9, Canada. senglish@ohri.ca.|Centre for Transfusion Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada. senglish@ohri.ca.
Shane W
SW
English
Centre for Transfusion Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada. mchasse@ohri.ca.
Michaël
M
Chassé
Department of Anesthesia (Critical Care), Hôpital L'Enfant-Jésus, 1401, 18e Rue, H-037, Québec, QB, G1J 1Z4, Canada. Alexis.turgeon@fmed.ulaval.ca.
Alexis F
AF
Turgeon
Centre for Transfusion Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada. atinmouth@ohri.ca.
Alan
A
Tinmouth
Department of Anesthesia (Critical Care), Hôpital L'Enfant-Jésus, 1401, 18e Rue, H-037, Québec, QB, G1J 1Z4, Canada. Amelie.boutin.2@ulaval.ca.
Amélie
A
Boutin
Department of Medicine (Critical Care), The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Rm F202, Ottawa, ON, K1Y 4E9, Canada. gpagliarello@toh.on.ca.
Giuseppe
G
Pagliarello
Centre for Transfusion Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada. dafergusson@ohri.ca.
Dean
D
Fergusson
Department of Medicine (Critical Care), The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Rm F202, Ottawa, ON, K1Y 4E9, Canada. lmcintyre@ohri.ca.|Centre for Transfusion Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada. lmcintyre@ohri.ca.
Lauralyn
L
McIntyre
D000740:Anemia / Q000209:etiology / Q000628:therapy*; D002985:Clinical Protocols; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D004912:Erythrocytes; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000401:mortality; D012107:Research Design; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000401:mortality; D000078202:Systematic Reviews as Topic; D015201:Meta-Analysis as Topic