TY - JOUR
T1 - Prophylactic furosemide to prevent transfusion-associated circulatory overload
T2 - a randomized controlled study in rats
AU - Klanderman, Robert B.
AU - Bosboom, Joachim J.
AU - Veelo, Denise P.
AU - Roelofs, Joris J. T. H.
AU - de Korte, Dirk
AU - van Bruggen, Robin
AU - Vogt, Liffert
AU - van Buul, Jaap D.
AU - Hollmann, Markus W.
AU - Vroom, Margreeth B.
AU - Juffermans, Nicole P.
AU - Geerts, Bart F.
AU - Vlaar, Alexander P. J.
N1 - Funding Information: Support was provided from departmental resources as well as support by a Landsteiner Foundation for Blood Research (LSBR) fellowship Grant to A.P.J. Vlaar, number 1931F. From the Landsteiner Foundation for Blood Transfusion Research, Haarlem—The Netherlands. Publisher Copyright: © 2022, The Author(s).
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Transfusion-associated circulatory overload (TACO) is the leading cause of transfusion related morbidity and mortality. The only treatment is empirical use of furosemide. Our aim was to investigate if furosemide can prevent TACO. A randomized controlled trial was performed using a previously validated two-hit rat model for TACO. Volume incompliance was induced (first hit) in anemic, anesthetized Lewis rats. Rats were randomized to placebo, low-dose (5 mg kg−1) or high-dose (15 mg kg−1) furosemide-administered prior to transfusion (second-hit) and divided over two doses. Primary outcome was change in left-ventricular end-diastolic pressure (∆LVEDP) pre- compared to post-transfusion. Secondary outcomes included changes in preload, afterload, contractility and systemic vascular resistance, as well as pulmonary outcomes. Furosemide treated animals had a significantly lower ∆LVEDP compared to placebo (p = 0.041), a dose–response effect was observed. ∆LVEDP in placebo was median + 8.7 mmHg (IQR 5.9–11), + 3.9 (2.8–5.6) in the low-dose and 1.9 (− 0.6 to 5.6) in the high-dose group. The effect of furosemide became apparent after 15 min. While urine output was significantly higher in furosemide treated animals (p = 0.03), there were no significant changes in preload, afterload, contractility or systemic vascular resistance. Furosemide rapidly and dose-dependently decreases the rise in hydrostatic pulmonary pressure following transfusion, essential for preventing TACO.
AB - Transfusion-associated circulatory overload (TACO) is the leading cause of transfusion related morbidity and mortality. The only treatment is empirical use of furosemide. Our aim was to investigate if furosemide can prevent TACO. A randomized controlled trial was performed using a previously validated two-hit rat model for TACO. Volume incompliance was induced (first hit) in anemic, anesthetized Lewis rats. Rats were randomized to placebo, low-dose (5 mg kg−1) or high-dose (15 mg kg−1) furosemide-administered prior to transfusion (second-hit) and divided over two doses. Primary outcome was change in left-ventricular end-diastolic pressure (∆LVEDP) pre- compared to post-transfusion. Secondary outcomes included changes in preload, afterload, contractility and systemic vascular resistance, as well as pulmonary outcomes. Furosemide treated animals had a significantly lower ∆LVEDP compared to placebo (p = 0.041), a dose–response effect was observed. ∆LVEDP in placebo was median + 8.7 mmHg (IQR 5.9–11), + 3.9 (2.8–5.6) in the low-dose and 1.9 (− 0.6 to 5.6) in the high-dose group. The effect of furosemide became apparent after 15 min. While urine output was significantly higher in furosemide treated animals (p = 0.03), there were no significant changes in preload, afterload, contractility or systemic vascular resistance. Furosemide rapidly and dose-dependently decreases the rise in hydrostatic pulmonary pressure following transfusion, essential for preventing TACO.
UR - http://www.scopus.com/inward/record.url?scp=85134220974&partnerID=8YFLogxK
U2 - https://doi.org/10.1038/s41598-022-16465-z
DO - https://doi.org/10.1038/s41598-022-16465-z
M3 - Article
C2 - 35840620
SN - 2045-2322
VL - 12
JO - Scientific reports
JF - Scientific reports
IS - 1
M1 - 12127
ER -