Transfusion-associated circulatory overload

Transfusion-associated circulatory overload (TACO) remains a leading cause of transfusion-related morbidity and mortality, accounting for 21% of the transfusion-related fatalities reported to the United States Federal Drug Administration in 2012. While its constellation of symptoms has been recognized for over half a century, effective preventative and/or therapeutic interventions for patients with or at risk for TACO remain limited. Presently, we are primarily left with supportive cares such as oxygen supplementation and ventilator support when needed. The intensive care unit (ICU) remains one of the highest utilizers of blood products in the hospital, with one out of every two patients receiving at least one allogeneic blood component during their ICU admission. As such, critical care physicians are in a privileged position whereby accurate identification of TACO cases may not only improve patient outcomes, but may also contribute meaningfully to our understanding of TACO’s epidemiology, pathophysiology, and true attributable burden. Improved case recognition will ultimately depend upon the development and acceptance of a consensus definition for TACO. In the absence of any proven therapeutic measures for TACO, perhaps the most appropriate preventative strategy is the avoidance of unnecessary transfusions through the use of conservative, evidence-based transfusion practices.