Megan E Cunningham1, Eric H Rosenfeld1, Huirong Zhu1, Bindi J Naik-Mathuria1, Robert T Russell2, Adam M Vogel3. 1. Department of Pediatric Surgery, Texas Children's Hospital, Houston, Texas. 2. Department of Pediatric Surgery, Children's of Alabama, Birmingham, Alabama. 3. Department of Pediatric Surgery, Texas Children's Hospital, Houston, Texas. Electronic address: amvogel@texaschildrens.org.
Abstract
BACKGROUND: Massive transfusion protocols with balanced blood product ratios have been associated with improved outcomes in adult trauma. The impact on pediatric trauma is unclear. MATERIAL AND METHODS: A retrospective review of the Pediatric Trauma Quality Improvement Program data set was performed using data from January 2015 to December 2016. Trauma patient's ≤ 18 y of age, who received red blood cells (RBCs) and were massively transfused were included. Children with burns, dead on arrival, and nonsurvivable injuries were excluded. Outcome data and mortality were assessed based on low (<1:2), medium (≥1:2, <1:1), and high (≥1:1) plasma and platelet to RBC ratios. RESULTS: There were 465 children included in the study (median age, 8 [2-16] y; median injury severity score, 34 [29-34]; mortality rate, 38%). Those transfused a medium plasma:RBC ratio received the greatest blood product volume in 24 h (90 [56-164] mL/kg; P < 0.01). Those in the low plasma:RBC group underwent fewer hemorrhage control procedures [56 (34%); P < 0.01], but ratio was not significant when controlling for age and other variables. Survival was improved for those who received a high plasma:RBC ratio (P = 0.02). Platelet transfusions were skewed toward lower ratios (95%) with no difference in clinical outcomes between the groups. CONCLUSIONS: A high ratio of plasma:RBC may result in decreased mortality in severely injured children receiving a massive transfusion. Prospective, multicenter studies are needed to determine optimal resuscitation strategies for these critically ill children.
BACKGROUND: Massive transfusion protocols with balanced blood product ratios have been associated with improved outcomes in adult trauma. The impact on pediatric trauma is unclear. MATERIAL AND METHODS: A retrospective review of the Pediatric Trauma Quality Improvement Program data set was performed using data from January 2015 to December 2016. Traumapatient's ≤ 18 y of age, who received red blood cells (RBCs) and were massively transfused were included. Children with burns, dead on arrival, and nonsurvivable injuries were excluded. Outcome data and mortality were assessed based on low (<1:2), medium (≥1:2, <1:1), and high (≥1:1) plasma and platelet to RBC ratios. RESULTS: There were 465 children included in the study (median age, 8 [2-16] y; median injury severity score, 34 [29-34]; mortality rate, 38%). Those transfused a medium plasma:RBC ratio received the greatest blood product volume in 24 h (90 [56-164] mL/kg; P < 0.01). Those in the low plasma:RBC group underwent fewer hemorrhage control procedures [56 (34%); P < 0.01], but ratio was not significant when controlling for age and other variables. Survival was improved for those who received a high plasma:RBC ratio (P = 0.02). Platelet transfusions were skewed toward lower ratios (95%) with no difference in clinical outcomes between the groups. CONCLUSIONS: A high ratio of plasma:RBC may result in decreased mortality in severely injured children receiving a massive transfusion. Prospective, multicenter studies are needed to determine optimal resuscitation strategies for these critically illchildren.
Authors: Robert Russell; David F Bauer; Susan M Goobie; Thorsten Haas; Marianne E Nellis; Daniel K Nishijima; Adam M Vogel; Jacques Lacroix Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.624
Authors: Marianne E Nellis; Kenneth E Remy; Jacques Lacroix; Jill M Cholette; Melania M Bembea; Robert T Russell; Marie E Steiner; Susan M Goobie; Adam M Vogel; Gemma Crighton; Stacey L Valentine; Meghan Delaney; Robert I Parker Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.971
Authors: Julie C Leonard; Cassandra D Josephson; James F Luther; Stephen R Wisniewski; Christine Allen; Fabrizio Chiusolo; Adrienne L Davis; Robert A Finkelstein; Julie C Fitzgerald; Barbara A Gaines; Susan M Goobie; Sheila J Hanson; Hilary A Hewes; Laurie H Johnson; Mark O McCollum; Jennifer A Muszynski; Alison B Nair; Robert B Rosenberg; Thomas M Rouse; Athina Sikavitsas; Marcy N Singleton; Marie E Steiner; Jeffrey S Upperman; Adam M Vogel; Hale Wills; Margaret K Winkler; Philip C Spinella Journal: Crit Care Med Date: 2021-11-01 Impact factor: 9.296