First10 EM - By Justin Morgenstern - March 27, 2023
Bottom line
Although it is reasonable to use a balanced transfusion strategy while waiting for more science, it is unreasonable to talk about it as a proven standard of care.
We need to be careful in our choice of language. Evidentiary amnesia leads to the repeated phenomenon of “medical reversal”, even though these supposed “reversing” studies perfectly match with the available research. Given that the only RCT ever published on balanced transfusion was negative, we shouldn’t be surprised if a future high quality RCT is also negative. (Especially when the other pilot RCT had massively worse outcomes.)
Most importantly, when we discuss medical interventions, let’s try to avoid evidentiary amnesia. Let’s openly discuss our uncertainty. I think it will help end the seemingly endless cycle of predictable ‘medical reversals’.