Massive transfusion in pediatric trauma: An ATOMAC perspective

Area of Science:

• Pediatric Trauma Care
• Resuscitation Science
• Hemorrhagic Shock Management

Background:

• Massive transfusion protocols (MTPs) are critical in pediatric trauma care.
• Optimal blood component ratios for MTPs in children remain unclear.
• Understanding survival benefits is essential for improving outcomes.

Purpose of the Study:

• To investigate the association between packed red blood cell to fresh frozen plasma (PRBC:FFP) ratios and survival in pediatric trauma patients.
• To determine the optimal PRBC:FFP ratio for massive transfusions in severely injured children.

Main Methods:

• Retrospective review of data from five Level I Pediatric Trauma Centers (2007-2013).
• Inclusion criteria: children (≤18 years) receiving MTP or >20 mL/kg PRBCs.
• Analysis of patient demographics, injury severity, and transfusion ratios.

Main Results:

• 110 pediatric trauma patients met inclusion criteria; 73% survived.
• Survival rates were not significantly different based on initial hemoglobin, gender, or age.
• Increased mortality was associated with PRBC:FFP ratios higher than 1:1 (OR 3.08).

Conclusions:

• A 1:1 PRBC:FFP ratio is associated with the highest survival in pediatric trauma patients undergoing massive transfusion.
• Ratios of 2:1 or higher significantly increase the risk of death.
• Findings support increased use of plasma products in pediatric massive transfusion protocols.