Intraoperative transfusion practices in Europe

BACKGROUND: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. METHODS: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. RESULTS: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). CONCLUSION: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. CLINICAL TRIAL REGISTRATION: NCT 01604083

A 4 tonne demonstrator for large-scale dual-phase liquid argon time projection chambers

A 10 kilo-tonne dual-phase liquid argon TPC is one of the detector options considered for the Deep Underground Neutrino Experiment (DUNE). The detector technology relies on amplification of the ionisation charge in ultra-pure argon vapour and offers several advantages compared to the traditional single-phase liquid argon TPCs. A 4.2 tonne dual-phase liquid argon TPC prototype, the largest of its kind, with an active volume of 3 × 1 × 1 m3 has been constructed and operated at CERN. In this paper we describe in detail the experimental setup and detector components as well as report on the operation experience. We also present the first results on the achieved charge amplification, prompt scintillation and electroluminescence detection, and purity of the liquid argon from analyses of a collected sample of cosmic ray muons.peerReviewe