Implementation of a pediatric trauma massive transfusion protocol: one institution's experience

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...

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Bibliographic Details
Published in:Transfusion (Philadelphia, Pa.) Pa.), 2012-06, Vol.52 (6), p.1228-1236
Main Authors: 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.
Format: Article
Language:English
Subjects:
Adolescent
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood Coagulation Disorders - epidemiology
Blood Coagulation Disorders - etiology
Blood Coagulation Disorders - mortality
Blood Transfusion - methods
Blood Transfusion - mortality
Blood Transfusion - standards
Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis
Child
Child, Preschool
Cohort Studies
Emergency and intensive care: neonates and children. Prematurity. Sudden death
Erythrocyte Transfusion - adverse effects
Erythrocyte Transfusion - mortality
Erythrocyte Transfusion - statistics & numerical data
Health Plan Implementation - methods
Humans
Infant
Infant, Newborn
Intensive care medicine
Medical sciences
Pediatrics - methods
Pediatrics - standards
Pediatrics - statistics & numerical data
Platelet Transfusion - adverse effects
Platelet Transfusion - mortality
Platelet Transfusion - statistics & numerical data
Resuscitation - methods
Retrospective Studies
Transfusion Reaction
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
Trauma Centers - standards
Wounds and Injuries - epidemiology
Wounds and Injuries - mortality
Wounds and Injuries - therapy
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Summary: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 
ISSN:0041-1132
1537-2995
DOI:10.1111/j.1537-2995.2011.03458.x