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

Area of Science:

• Pediatric Trauma Care
• Hemorrhagic Shock Management
• Blood Product Transfusion

Background:

• Massive transfusion protocols (MTPs) with fixed ratios improve outcomes in adult coagulopathic trauma patients.
• Limited data exists on MTPs for pediatric trauma patients due to differing injury mechanisms.
• This study investigated the feasibility and impact of an MTP in pediatric trauma.

Purpose of the Study:

• To evaluate the feasibility of a pediatric trauma MTP.
• To assess the impact of MTP on blood product resuscitation in children.
• To determine if MTP improves outcomes in pediatric trauma patients.

Main Methods:

• A pediatric trauma MTP with weight-based fixed ratios of RBCs, FFP, platelets, and cryoprecipitate was implemented.
• Clinical data, resuscitation volumes, and hospital course were collected.
• Data was compared to a pre-MTP cohort of pediatric trauma patients requiring transfusion.

Main Results:

• Seventy-two percent of MTP patients presented with coagulopathy in the ED.
• Median time to FFP transfusion decreased fourfold post-MTP implementation (p<0.0001).
• The 24-hour FFP:RBC transfusion ratio was significantly higher in MTP patients (1:1.8 vs. 1:3.6; p=0.002), but no mortality improvement was observed.

Conclusions:

• A pediatric trauma MTP is feasible, facilitating rapid, balanced blood product transfusion.
• The protocol allows for timely correction of coagulopathy in pediatric trauma.
• Larger studies are needed to confirm if MTPs improve outcomes in this population.