Citations 2
Cold and Room-Temperature Platelets in Cardiac Surgery
Spinella, Philip C., Zantek, Nicole D., Nicolson, Susan C., Khanna, Ashish K., Boisen, Michael L., Williams, Tiffany M. , Monteleone, Matthew, Pavey, Warren, Smith, Bradford B., Ahmed, M. Iqbal, Jeng, Eric, Flynn, B S, Joshi, Ravi V. , Preuss, James , Goswami, Dheeraj, Lewis, Choy, Tint, Hlaing , Kwak, Jenny , Sodha, Neel, Simon, Eric R. , Van, Philbert Y., Greilich, Philip E. , Booth, Frank V. McL., Carter, Camille, Keegan, Anastazia , Cap, Andrew P., Matuk, James, McGlothlin, Anna, Berry, Nicholas , Lewis, Roger , Steiner, Marie E., Group, CHIPS Investigator, Hu, Paula, Hawkins, Jaleah, Jobes, David R. , Fadeyi, Emmanuel A. , Reynolds, Abigail M.A., Bell, Carter G., Gandhi, Manish J., Montonye, Beth, Serna-Gallegos, Derek, Sultan, Ibrahim, Kinney, Stephanie , Molony, Kathleen, Hensch, Lisa, Resheidat, Ashraf, Malivers, Martine, Hahn, Rebbecca, Viellez, Annette Le, Pepperell, Dominic , Lu, Qun, Downey, Frank, Haeger, Kayla N., Baltagi, Sirine , Jaquiss, Robert D.B., Noland, Daniel K., Cole, Regina, Duffin, Aspen, Scott, John P., Zeng, Long, Ballew, Angie, Webb, Christopher, Jessen, Michael, Hopson, Erryn, Mickle, Peri, Kavanagh, Simon, Matzelle, Shannon, Mennie, Colleen, Davenport, Robertson, Chlebeck, Therese, Zenk, Emmy, Lotz, Daniel T., Choi, Warren , Hobbs, Rhonda, Baptise, Amanda, DeChristopher, Phillip, Schoenecker, Nancy, Rodheim, Dianna, Connor, Joseph, Griese, Daniel J., McGuire, Erin, VanSandt, Mandy, Sera, Valerie, O’Donovan, Justine , Marks, Denese, Johnson, Lacey, Viele, Kert , Cholette, Jill M., Selke, Frank, Silverman, Toby, Shea, Susan, Yazer, Mark, Young, P. J., Ness, Paul Van, Dean, J. Michael, Shaz, Beth, Stubbs, James, Klompas, Allan M. , Spinella, Philip C. , Zantek, Nicole D. , VanBuren, John M. , Nicolson, Susan Craig , Khanna, Ashish K. , Boisen, Michael L , Monteleone, Matthew P., Bashir, Dalia A. , Pavey, Warren , Niebler, Robert A. , Jeng, Eric I-Hun , Goswami, Dheeraj , Yamada, Chisa , Lewis, Choy R., Cohn, Claudia S. , Sodha, Neel R. , Cap, Andrew , Matuk, James , Smith, Mark M. , Montonye, Beth L., Kaplan, Alesia , Kinney, Stephanie , Resheidat, Ashraf M., Downey, Francis X. , Ballew, Angie , Matzelle, Shannon A, Crowe, Liz , DeChristopher, Phillip J., Griese, Daniel, Sera, Valerie, Marks, Denese C. , Johnson, Lacey , Cholette, Jill M., Levy, Jerrold H. , Silverman, Toby , Yazer, Mark H. , Strandenes, Geir , Shaz, Beth H. , Stubbs, James R.
JAMA | August 17, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Importance Patients undergoing cardiac surgery with cardiopulmonary bypass often require platelet transfusions for bleeding. Platelets are routinely stored at room temperature (20-24 °C) for up to 5 to 7 days; however, cold storage (1-6 °C) may allow for increased storage duration without loss of hemostatic function. Objective To determine the maximum cold-storage duration, up to 21 days, for which cold-stored platelets (CSPs) are noninferior or superior in hemostatic efficacy to room-temperature platelets (RTPs) when transfused in actively bleeding patients undergoing cardiac surgery with cardiopulmonary bypass. Design, Setting, and Participants A phase 3, multicenter, randomized, partially blinded, adaptive, noninferiority, storage duration–ranging trial conducted in pediatric and adult patients undergoing cardiac surgery with planned cardiopulmonary bypass at 27 sites in the US and Australia from December 2021 to March 2025. Statistical analysis was conducted from September 9 to October 3, 2025. Intervention Patients were randomized 2:1 to receive CSPs with a maximum of 21 days of storage vs RTPs with a maximum of 7 days of storage. Main Outcomes and Measures The primary outcome was a hemostatic efficacy score with values ranging from 1 to 5 and higher values indicating greater bleeding. The noninferiority margin was 1 point. The success criterion was met if at least 1 cold-storage duration of 7 days or more had a posterior probability of noninferiority of at least 97.5%. The secondary outcome was 24-hour chest tube output. Results Of the 1000 patients who underwent platelet transfusion, 989 were included in the primary analysis (650 CSPs and 339 RTPs). The cohort had a mean (SD) age of 42.1 (30.1) years and 67.8% were male. CSPs were noninferior to RTPs for the primary outcome, with a probability of greater than 99.9% for all cold-storage durations. Pooled across storage durations, CSPs had a mean difference from RTPs of 0.09 (95% credible interval, −0.06 to 0.23). Median (IQR) chest tube output at 24 hours (8.9 mL/kg [5.2-15.4] for CSPs vs 8.4 mL/kg [5.5-15.9] for RTPs; difference in medians, 0.4 [95% CI, −1.0 to 1.5]) was not statistically different between study groups. In a post hoc analysis, as all storage durations were noninferior, considering the CSPs as a single group, the hemostatic efficacy score was similar between both groups: mean (SD) of 3.08 (1.15) CSPs vs 2.99 (1.10) RTPs. There were no differences in venous or arterial thrombotic events, transfusion-associated adverse events, acute respiratory distress syndrome, kidney failure, septic shock, and mortality between the study groups, except for increased reexploration rates in the CSP group. Conclusions and Relevance For patients undergoing cardiac surgery, CSPs stored up to 21 days are noninferior to RTPs for the control of active surgical bleeding. Use of CSPs may allow for increased availability of platelets by reducing wastage and shortages and may allow for incorporation of platelets into inventory at locations where platelets cannot be maintained due to the 5- to 7-day shelf life of RTPs. Trial Registration ClinicalTrials.gov Identifier: NCT04834414
Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak
Halasa, Natasha , Zambrano, Laura D. , Stewart, Laura S , Newhams, Margaret M. , Levy, Emily R. , Carroll, Christopher L. , Fitzgerald, Julie C. , Bline, Katherine , Cullimore, Melissa L. , Loftis, Laura L. , Jeyapalan, Asumthia , Schwarz, Adam J. , Zinter, Matt S. , Irby, Katherine , Kuebler, Joseph D. , Babbitt, Christopher , Gaspers, Mary Glas , Nofziger, Ryan A. , Kong, Michele , Coates, Bria M. , Schuster, Jennifer E. , Gertz, Shira J. , Mack, Elizabeth H. , White, Benjamin R. , Harvey, Helen , Butler, Andrew , Bradford, Tamara T. , Rowan, Courtney M. , Staat, Mary Allen , Aguiar, Cassyanne L. , Randolph, Adrienne G. , Campbell, Angela P. , Investigators, RSV-PIC, Tomcany, Merry, Price, Heather E. , Sanders, Ronald C., Dixon, Lexie, Kücükak, Suden, McNamara, Elizabeth R, Chen, Sabrina R., Listerud, Eve, Vargas-Shiraishi, Ofelia, Oberle, Betty, Zorensky, Frances, Mansour, Rachel, Jumarang, Jaycee , Johnston, Marla , Bush, Jenny L., Dickey, Shawn, Sullivan, Melissa, Kietzman, Abigail , Colston, Candice , Murdock, Meghan, Kelley, Heather M., Wright-Sexton, Laura, Martin, Maygan, Malloch, Lacy , Patterson, Kayla, Sanders, Cameron , Rohlfs, Chelsea , Rice, Marilyn, Howard, Miranda, Murphy, M. Gail, Soma, Vijaya L, Job, Megan , Mennie, Colleen, Simkhada, Kamala, Drapeau, Noelle M., Hayek, Haya , Maranto, Molly, Waters, Aubrie, Flowers, Maggie, Havlin, Kevin , Furlong-Dillard, Jamie , Porter, Melissa , Nason, Jennifer, Ray, Madison, Gossett, Kristen, Crandall, Hillary , Heller, Evan G, Foley, Jennifer, Rasal, Rajashri, Marlow, Christine, Senthil, Anurithi, Myers, Kimberly, Tudor, Betsy, Garcia, Nereyda, Treister, Natalie, Sun, Kathleen, Villarreal-Chico, Denise, Kainaroi, Sophia, Levy, Emily R , Randolph, Adrienne G , Kong, Michele , Staat, Mary A , Gertz, Shira J , Bline, Katherine E , Amarin, Justin Z. , Shein, Steven L. , Michaels, Marian G , Montgomery, Vicki , Pannaraj, Pia S. , Cvijanovich, Natalie Z , Maddux, Aline B. , Bembea, Melania M. , Zerr, Danielle M. , Hobbs, Charlotte V. , Dapul, Heda , Wellnitz, Kari , Hymes, Saul , Investigators, RSV-PIC, Michelson, Kelly Nicole , Typpo, Katri , Harwayne‐Gidansky, Ilana , Bush, Jenny, Hill, Shannon, Kelley, Heather, Martin, Lora , Rice, Marilyn, Howard, Miranda, Murphy, Makayla, Ratner, Adam J. , Behl, Supriya , Betters, Kristina Ann , Maranto, Molly , Nason, Jennifer, Marlow, Christine, Myers, Kimberly, Adler, Amanda , Garcia, Nereyda, McQuillen, Patrick S. , Williams, John V.
JAMA Network Open | August 15, 2023 | Volume: 6 | Issue: 8 | Pages: e2328950
10.1001/jamanetworkopen.2023.28950
ImportanceRespiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.ObjectiveTo evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission.Design, Setting, and ParticipantsThis cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states. Participants were infants admitted for 24 or more hours between October 17 and December 16, 2022, to a unit providing intensive care due to laboratory-confirmed RSV infection.ExposureRespiratory syncytial virus.Main Outcomes and MeasuresData were captured on demographics, clinical characteristics, signs and symptoms, laboratory values, severity measures, and clinical outcomes, including receipt of noninvasive respiratory support, invasive mechanical ventilation, vasopressors or extracorporeal membrane oxygenation, and death. Mixed-effects multivariable log-binomial regression models were used to assess associations between intubation status and demographic factors, gestational age, and underlying conditions, including hospital as a random effect to account for between-site heterogeneity.ResultsThe first 15 to 20 consecutive eligible infants from each site were included for a target sample size of 600. Among the 600 infants, the median (IQR) age was 2.6 (1.4-6.0) months; 361 (60.2%) were male, 169 (28.9%) were born prematurely, and 487 (81.2%) had no underlying medical conditions. Primary reasons for admission included LRTI (594 infants [99.0%]) and apnea or bradycardia (77 infants [12.8%]). Overall, 143 infants (23.8%) received invasive mechanical ventilation (median [IQR], 6.0 [4.0-10.0] days). The highest level of respiratory support for nonintubated infants was high-flow nasal cannula (243 infants [40.5%]), followed by bilevel positive airway pressure (150 infants [25.0%]) and continuous positive airway pressure (52 infants [8.7%]). Infants younger than 3 months, those born prematurely (gestational age <37 weeks), or those publicly insured were at higher risk for intubation. Four infants (0.7%) received extracorporeal membrane oxygenation, and 2 died. The median (IQR) length of hospitalization for survivors was 5 (4-10) days.Conclusions and RelevanceIn this cross-sectional study, most US infants who required intensive care for RSV LRTIs were young, healthy, and born at term. These findings highlight the need for RSV preventive interventions targeting all infants to reduce the burden of severe RSV illness.