1. RBWH ICU JOURNAL CLUB
NOVEMBER 2014

3. Summary Questions asked Jistorical background Trial design Patients
Results
Discussion

4. Questions asked Does higher Hb threshold improve neurological outcome
Does EPO do more than just estimulate the bone marrow

5. Evolution
Silver, CCM 2006; EPO decreases the need for RBC transfusions in critically ill
Corwin, NEJM 2007; More VTE but maybe improved mortality in trauma
Napolitano, JTrauma, 2008; IU EPO improves mortality by 50% at 29 days(n=2760)
EAST, CCM, 2009; Level 2 recommendation on EPO administration in general trauma
Desjardins, CC, A Systematic Review (n=4100) could not find a difference in Hb threshold and outcomes in TBI

6. EPO upregulates antiapoptosis messenger in brain (and spine)
J Exp Med. Sep 15, 2003; 198(6): 971–975.
doi:  /jem

8. What about Hb thresholds?

9. Trial design Multiple level 1 or 2 trauma centres in Houston
2X2 design
Enrolment within 6 hours from injury
EPO or no EPO
Transfusion thresholds 7 or 10g/dL
Blinded for EPO but not for Hb threshold
Power of study changed with EPO dosing

10. 500IU $1.35/100IU

13. Patients N= 200; x4 groups but in reality x6
Closed head injury with GCS>3
Changed EPO dosing
Blinding for EPO

15. Outcomes Glasgow outcome score Mortality Respiratory failure
Infections
EPO levels

16. Results No difference in outcome scores with either intervention
Perhaps more VTE’s in the high Hb group

19. Discussion EPO costs money and probably gives no benefit
Blood costs money
Blood is a scarce resource and could cause harm
NOT giving blood in hemodyanmic stable non bleeding patients is safe