Trends in blood conservation in burn care

Traditional burn surgery is very bloody, but wide use of blood conserving strategies is becoming common. Uniform application of blood conserving techniques of burn wound excision may substantially decrease blood utilization in burn patients. We chose to examine this trend in our unit. All fresh frozen plasma (FFP) and packed red blood cell (pRBC) use in children with burns of 10% or more of the body surface who were admitted during 2-3 year intervals, separated by a decade, was reviewed in detail. Three subgroups were separately analyzed: children with 10-24% (small), 25-49% (medium) and 50-100% (large) body surface area burns. Between these two intervals a major emphasis was made in techniques of blood conservation during surgery and fresh frozen plasma was replaced by 5% albumin as the routine resuscitative colloid. In Group 1, there were 189 children, of whom 184 (97%) survived to discharge. In Group 2, there were 203 children, of whom 199 (98%) survived to discharge (N.S.). All subgroups were well matched for age, weight and burn size. Discharge hemocrits exceeded 30% in all subgroups. Reductions in FFP use were 100, 95 and 97% in the small, medium and large burn size groups, respectively. Reductions in pRBC use were 89, 63, and 80% in the small, medium and large burn size groups, respectively. These differences were all highly significant (P<0.001). Uniform application of blood conserving techniques of burn wound excision result in highly significant reductions in blood product exposure without sacrifice of clinical outcomes.