Cold and Room-Temperature Platelets in Cardiac Surgery: The CHIPS Randomized Clinical Trial.

In 30 seconds

The phase 3, multicenter, randomized CHIPS trial compared cold-stored platelets (CSPs; up to 21 days) with room-temperature platelets (RTPs; up to 7 days) in pediatric and adult patients receiving platelet transfusions for active bleeding during cardiac surgery with cardiopulmonary bypass. Among 989 patients in the primary analysis, CSPs met the trial’s noninferiority criterion for hemostatic efficacy at every storage duration, with a probability greater than 99.9%. Twenty-four-hour chest tube output was not statistically different between groups. Reexploration rates were higher with CSPs; other reported adverse outcomes did not differ.

Key findings

• CSPs were noninferior to RTPs for hemostatic efficacy at all tested storage durations, with a probability greater than 99.9%.
• Pooled across storage durations, the mean difference in hemostatic efficacy score was 0.09 (95% credible interval, -0.06 to 0.23).
• Median 24-hour chest tube output was 8.9 mL/kg [5.2-15.4] with CSPs and 8.4 mL/kg [5.5-15.9] with RTPs; the difference was not statistically significant.
• Reexploration rates were higher in the CSP group; other listed adverse outcomes did not differ between groups.

Why it matters

The findings support cold storage as a potential way to extend platelet availability for cardiac surgery without compromising the measured control of active bleeding, including when storage extends to 21 days. Longer storage could help reduce wastage and shortages and make platelet inventory feasible in settings where short room-temperature shelf life is a barrier. The higher reexploration rate warrants attention when interpreting the overall safety findings.

What to keep in mind

The trial population was limited to patients undergoing cardiac surgery with cardiopulmonary bypass who received platelet transfusions; applicability to other settings is not established by this study.