Effect of Red Blood Cell Storage Duration on Cerebral Blood Oxygenation in Elective Cranial Surgery: A Prospective Randomized Controlled Study

TL;DR

This study found that using older stored blood during brain surgery does not harm patients' brain oxygen levels or recovery outcomes.

Contribution

The study provides clinical evidence on the safety of using older stored red blood cells in neuro-oncological surgery.

Findings

Older stored blood caused a temporary increase in cerebral oxygen saturation but no lasting effects.

No significant differences in neurological outcomes or hospital stays between groups.

Hemodynamic and blood gas values were similar between the two groups.

Abstract

Background: The clinical significance of storage-related changes in packed red blood cells (PRBCs), termed “storage lesions,” remains controversial. These biochemical and structural alterations may affect oxygen delivery, particularly in patients undergoing neurosurgical procedures, where cerebral oxygenation is critical. This study aimed to evaluate the effect of PRBC storage duration on cerebral oxygenation and neurological outcomes in patients undergoing elective neuro-oncological surgery.

Methods: In this prospective, double-blind, randomized controlled trial, 80 adult patients (American Society of Anesthesiologists (ASA) physical status I-II) scheduled for elective neuro-oncological surgery were enrolled and randomized into two groups: Group N (PRBCs stored <14 days) and Group O (PRBCs stored >14 days). Standard general anesthesia protocols were followed. Jugular bulb catheters were placed for serial monitoring of cerebral oxygenation parameters (saturation of jugular venous oxygen (SjvO₂), partial pressure of jugular venous oxygen (PjvO₂), lactate, and potential of hydrogen (pH)). Hemodynamic and blood gas values were recorded at baseline and hourly intraoperatively. Neurological outcomes were assessed using the Glasgow Outcome Scale-Extended (GOSE) scores at hospital discharge.

Results: Demographic characteristics, intraoperative parameters (surgery duration, blood loss), and transfusion volumes were comparable between groups. Hemodynamic variables and arterial/jugular venous blood gas measurements showed no consistent or clinically significant differences. A transient increase in SjvO₂ was observed in Group O at one hour post transfusion (p < 0.05), but this was not sustained. There were no statistically significant differences in GOSE scores or ICU and hospital stay durations between groups.

Conclusion: The duration of PRBC storage did not significantly affect intraoperative cerebral oxygenation or early postoperative neurological outcomes in patients undergoing neuro-oncological surgery. These findings suggest that transfusion of older PRBCs (>14 days) is clinically safe in this setting.