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Principal Investigator(s)





Each year, 25 000 Canadians are hospitalized for a traumatic brain injury (TBI), by far the leading cause of permanent impairment and death in trauma. Over their intensive care unit (ICU) stay, most critically ill patients with TBI will develop anemia, which may decrease oxygen delivery to a fragile brain. While clinical practice is moving towards transfusing patients at low hemoglobin (Hb) levels with red blood cell (RBC) transfusion, several experts have expressed concerns regarding restrictive RBC transfusion strategies, which may adversely affect clinical outcomes in TBI. Also, current guidelines for the management of TBI are based on limited evidence and practices are highly variable, including for strategies to improve brain oxygen delivery such as blood transfusion. Thus, evidence-based driven data on what transfusion strategy to adopt in patients with TBI is unclear, as well as when benefits outweigh the risks associated with this intervention. We developed a research program to evaluate optimal transfusion strategies in patients with TBI. Our findings will allow for both optimal usage of a scarce resource and the proper understanding of the brain’s blood requirements in this vulnerable population.

In the HEMOTION trial, we hypothesize that, among critically ill adult patients with moderate or severe TBI, a liberal RBC transfusion strategy (triggered by Hb ≤100g/L) improves long-term functional outcomes compared to a restrictive strategy (triggered by Hb ≤70g/L). The HEMOTION trial is an international multicenter pragmatic open blinded-endpoint (PROBE) randomized trial. It is taking place in Canada and in the United Kingdom. The HEMOTION Trial is conducted in collaboration with the Canadian Traumatic Brain Injury Research Consortium (www.ctrc-ccrt.ca) and the PACT group (www.canadianpact.ca).

Relevant references:
  1. Boutin A, Chassé M, Shemilt M, Lauzier F, Moore L, Zarychanski R, Griesdale D, Desjardins P, Lacroix J, Fergusson D, Turgeon AF. Red blood cell transfusion in patients with traumatic brain injury: a systematic review and meta-analysis. Transfus Med Rev. 2016 Jan;30(1):15-24.
  2. Boutin A, Moore L, Lauzier F, Chassé M, English S, Zarychanski R, McIntyre L, Griesdale D, Fergusson DA, Turgeon AF. Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centers: a multicenter cohort study. BMJ Open. 2017 Mar 29;7(3):e014472.
  3. Boutin A, Moore L, Green RS, Zarychanski R, Erdogan M, Lauzier F, English S, Fergusson DA, Butler M, McIntyre L, Chassé M, Lessard Bonaventure P, Léger C, Desjardins P, Griesdale D, Lacroix J, Turgeon AF. Hemoglobin thresholds and red blood cell transfusion in adult patients with moderate or severe traumatic brain injuries: a retrospective cohort study. J Crit Care. 2018 Jun;45:133-139.
  4. Desjardins P, Turgeon AF, Tremblay MH, Lauzier F, Zarychanski R, Boutin A, Moore L, McIntyre LA, English SW, Rigamonti A, Lacroix J, Fergusson DA. Hemoglobin levels and transfusions in neurocritically ill patients: a systematic review of comparative studies. Crit Care. 2012;16(2):R54.
Funding :
Canadian Institutes of Health Research (CIHR)


Almunder Algird, Andrew Baker, Ian Ball, Gordon Boyd, Karen Burns, Emmanuel Charbonney, Michael Chassé, Julien Clément, Gilles Delage, Annemarie Docherty, Jean-Nicholas Dubé, Shane English, Robert Green, Donald Griesdale, Paul Hébert, Kosar Khwaja, Andreas Kramer, Jim Kutsogiannis, François Lamontagne, Vincent Laroche, Paule Lessard Bonaventure, John Marshall, Lynne Moore, Susan O’Leary, Richard Riopelle, Maude Saint-Onge, Damon Scales, Alan Tinmouth, Tim Walsh, Gordon Wood, Ryan Zarychanski.

Participating Centers