From the Guidelines
TACO, or Transfusion-Associated Circulatory Overload, is a serious complication of blood transfusions that occurs when the cardiovascular system becomes overwhelmed by the volume of transfused blood products, and it is now the most common cause of transfusion-related mortality and major morbidity. According to the most recent guidelines from the Association of Anaesthetists 1, TACO is broadly defined as acute or worsening respiratory compromise and/or acute or worsening pulmonary oedema during or up to 12 h after transfusion, cardiovascular changes (tachycardia, hypertension) not explained by the patient’s underlying condition, evidence of fluid overload and supportive result of a relevant biomarker (e.g. brain natriuretic peptide).
Key Points
- Risk factors for developing TACO include older, non-bleeding patients (age >70 years), comorbidities (heart failure, renal failure and hypoalbuminaemia), low body weight and rapid transfusion 1.
- Prevention strategies are crucial to minimize the risk of TACO, and these may include careful patient assessment, slower transfusion rates, and administration of diuretics for high-risk patients.
- Patient monitoring during the transfusion episode is essential to identify and manage adverse reactions, including TACO, with observations such as respiratory rate, pulse, blood pressure, and temperature being undertaken and documented for each unit transfused 1.
Management
- The management of TACO involves stopping the transfusion, elevating the patient's head, administering oxygen, and giving diuretics.
- It is critical to distinguish TACO from other transfusion-related complications, such as Transfusion-Related Acute Lung Injury (TRALI), to provide appropriate treatment.
Recommendations
- Healthcare providers should be vigilant for the signs and symptoms of TACO in patients receiving blood transfusions, particularly in those with risk factors, and take prompt action to prevent and manage this potentially life-threatening complication.
- The use of evidence-based guidelines, such as those from the Association of Anaesthetists 1, can help inform clinical practice and improve patient outcomes.
From the Research
Definition of TACO
- TACO stands for Transfusion-Associated Circulatory Overload, a potentially life-threatening complication of blood transfusion 2, 3, 4.
- It is associated with increased morbidity, length of stay in hospital and intensive care unit, and hospital costs 3.
Risk Factors for TACO
- Risk factors for TACO include being at an extreme of age, having preexisting cardiac and/or renal dysfunction, acute myocardial infarction, and individuals receiving plasma 2.
- Other risk factors include older than 70 years, history of congestive heart failure, ejection fraction <60%, and diastolic dysfunction 5.
Prevention and Management of TACO
- Keys to preventing TACO include identifying high-risk individuals, using pretransfusion checklists, and implementing nonemergent transfusion protocols 2.
- The use of pretransfusion diuretics, such as furosemide, in high-risk individuals is also suggested 2, 6, 5.
- Bedside nurses play a key role in the prevention, identification, and reporting of TACO 3.
- Surveillance and evidence-based strategies, such as clinical decision support systems, have the potential to reduce the incidence of TACO and mitigate its effects 3.
Diagnosis and Treatment of TACO
- The diagnosis of TACO can be challenging due to overlapping symptomatology with other conditions 4.
- A comprehensive understanding of the importance of hemovigilance and its role in appropriately identifying and reporting TACO is essential 4.
- Mitigation strategies, such as the use of diuretics, can help prevent complications of blood product transfusion, with emphasis on the prevention of TACO 4, 6, 5.