Premium
Implementation of a pediatric trauma massive transfusion protocol: one institution's experience
Author(s) -
Hendrickson Jeanne E.,
Shaz Beth H.,
Pereira Greg,
Parker Paul M.,
Jessup Paula,
Atwell Falisha,
Polstra Beth,
Atkins Elizabeth,
Johnson Karen K.,
Bao Gaobin,
Easley Kirk A.,
Josephson Cassandra D.
Publication year - 2012
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2011.03458.x
Subject(s) - medicine , cryoprecipitate , fresh frozen plasma , blood product , partial thromboplastin time , injury severity score , resuscitation , prothrombin time , blood transfusion , packed red blood cells , pediatric trauma , thromboelastography , transfusion therapy , emergency medicine , anesthesia , platelet , surgery , poison control , injury prevention
BACKGROUND: Massive transfusion protocols (MTPs) with fixed ratios of blood products may improve outcomes in coagulopathic adult trauma patients. However, there is a paucity of data on transfusion support protocols for pediatric trauma patients, whose mechanisms of injury may differ from those seen in adults. We hypothesized that an MTP would improve outcomes in children, through a balanced blood product resuscitation. STUDY DESIGN AND METHODS: A pediatric trauma MTP, with a fixed ratio of red blood cells (RBCs) : fresh‐frozen plasma (FFP) : platelets : cryoprecipitate in quantities based on the patient's weight, was initiated at a pediatric hospital. Data on clinical status, resuscitation volumes, and hospital course were collected and compared to data from pre‐MTP trauma patients requiring transfusion. RESULTS: Fifty‐three patients were enrolled over a 15‐month period and compared to 49 pre‐MTP patients. Seventy‐two percent of MTP patients had at least one coagulation value outside of the normal range upon emergency department (ED) arrival, and the median time to FFP transfusion decreased fourfold after MTP implementation (p < 0.0001). A total of 49% of MTP patients received greater than 70 mL/kg blood products, and the 24‐hour median FFP : RBC transfusion ratio was twofold higher in these patients than the pre‐MTP cohort (median, 1:1.8 vs. 1:3.6; p = 0.002). No improvement in mortality was observed after MTP implementation, taking into consideration injury severity, prothrombin time, and partial thromboplastin time. CONCLUSIONS: A pediatric trauma MTP is feasible and allows for rapid provision of balanced blood products for transfusion to coagulopathic children. Larger studies are warranted to determine whether such protocols will improve outcomes for pediatric trauma patients.