Old blood raises death risk in trauma patients receiving transfusions

A victim of severe trauma who gets as little as a single unit of blood that's been stored for more than a month is twice as likely to die as an equally injured patient who gets transfused with fresher blood, a new study finds.

Red blood cells stored longer than 28 days significantly increased trauma patients' risk of developing fatal deep vein thrombosis or multi-organ failure for six months after transfusion, a team of pediatric intensive-care specialists in Connecticut reported today in the journal Critical Care.

The new study is the latest to raise concerns about rules governing the use of about 29 million units of blood transfused every year in the United States. The American Red Cross says donated blood has a "shelf life" of 42 days, after which it must be discarded if not used.

Two earlier studies -- one looking at a general hospital population requiring transfusion and a second at heart surgery patients -- found that the use of longer-stored blood in transfusions resulted in poorer outcomes. Hospital patients administered blood stored longer than four weeks were three times as likely to acquire an infection in the hospital than those who got fresher blood. Heart patients infused with blood stored longer than two weeks were 64% more likely to die than those whose red blood cells were more briefly in storage.

Though hospitals typically use their longest-stored blood first to avoid wasting the precious resource, the authors of the Critical Care study suggest that physicians might consider the "preferential use" of younger blood on the most critically injured trauma patients. The result would likely mean more blood reaches its expiration date before it can be used. But lives could be saved.

-- Melissa Healy

Getting a speedy response to 'code blue'

Cardiac arrest happens frequently in hospitals, and efforts have been made in recent years to hasten the response of emergency resuscitation teams. According to a recent study, as many as 30% of in-hospital cardiac arrests from ventricular arrhythmias are not treated within the recommended two minutes or less. A delay of more than two minutes is linked to a 50% lower rate of survival.

It appears no one can be certain he or she is in a hospital with a speedy response time. A study published today in the Archives of Internal Medicine found rates of delayed defibrillation vary widely among hospitals for reasons that are hard to define. For example, traditional factors that suggest a hospital's level of expertise -- such as patient volume and being a teaching hospital -- were found in the study to be a poor predictor of how well cardiac arrest was handled at such facilities.

The researchers looked at defibrillation practices at 200 hospitals participating in the National Registry of Cardiopulmonary Resuscitation. They found rates of delayed defibrillation -- longer than two minutes -- varied from 2.4% to 50.9% among hospitals. The study had trouble identifying characteristics that seemed related to poor performance, such as hospital size or hospital-wide mortality rates. Only the number of beds in the hospital (larger hospitals performed better) and geographical location (such as whether the patient was in an intensive care unit) were linked to response time. Instead, how a given hospital responds seems to be related to such factors as how the individual hospital approaches the resuscitation process and develops tactics to improve response time, the authors said.

"This lack of correlation between 'conventional' hospital-level factors and defibrillation time suggests that other unmeasured characteristics are responsible for certain institutions achieving extremely low rates of delayed defibrillation," the authors wrote.

-- Shari Roan

Photo: Mohammed Abed / Agence France-Presse

Lifesaving chest compressions near-perfect when done to disco hit

Finally, a reason to have lived through the 70s -- and another fine reason to relive one of disco's most enduring triumphs, the 1977 hit by the Brothers Gibb, "Stayin' Alive": it could save someone's life.

In performing Cardiopulmonary Resuscitation -- CPR -- the perfect rhythm is 100 compressions per minute, and done properly, it can triple a heart arrest victim's chances of survival. But how, when you're saving a life, do you achieve that ideal rhythm of life-saving compressions? Think "Stayin' Alive."

Medical students and physicians trained to perform CPR to the bouncing beat of "Stayin' Alive" maintained close to the ideal rhythm recommended by the American Heart Assn. for chest compressions during CPR, according to a study to be presented Oct. 27 at a Scientific Assembly of the American College of Emergency Physician's annual meeting.

The small study set five med students and 10 physicians to the task of performing CPR to the soundtrack of "Stayin' Alive," a song with exactly 103 beats per minute. Five weeks later (it's not clear whether they got to return to the "Saturday Night Fever" soundtrack for a little disco refresher), the subjects still had their CPR rhythms close to perfect, at an average of 113 beats per minute.

Sure there are other pop songs that clock in at close to 100 beats per minute, said Dr. David Matlock of the University of Illinois Medical School. But could you do better than "Stayin' Alive" under the circumstances?

-- Melissa Healy 

Photo credit: Paramount Pictures