Transfusion-Associated Circulatory Overload (TACO): Strategies to Mitigate the Risk of Harm

What is Transfusion-Associated Circulatory Overload (TACO)?TACO has been defined as "acute or worsening respiratory compromise and/or acute or worsening pulmonary [edema] during or up to 12 hours after transfusion, with additional features including cardiovascular system changes not explained by the patient's underlying medical condition, evidence of fluid overload and a relevant biomarker." 1 Definitions of TACO vary across the literature 1,2 and some of its features may overlap with the definition and presentation of transfusion-related acute lung injury (TRALI). 2,3Risk factors for and clinical presentation of TACO are reviewed in several resources 1,2,4 and we recommend that clinical staff read references 1, 2, and 4.Occurrence of TACO and Impact on Patients.The Medicines and Healthcare products Regulatory Agency in the United Kingdom released an April 2024 National Patient Safety Alert informing the healthcare community of an increasing trend of TACO-related deaths and major morbidity. 1Through an exploration of data in the Pennsylvania Patient Safety Reporting System (PA-PSRS), the Patient Safety Authority (PSA) also found that hundreds of TACO events have been reported across Pennsylvania in recent years, including reports of serious patient harm and death.PSA encourages the healthcare community to be aware of risk factors for, clinical presentation of, and strategies to mitigate the risk of TACO.