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Massive transfusion in pediatric trauma: An ATOMAC perspective

Daniel K Noland1, Nadja Apelt1, Cynthia Greenwell1

  • 1Children's Medical Center, the flagship of Children's Health(SM), 1935 Medical District Dr, Dallas, TX, USA 75235.

Journal of Pediatric Surgery
|November 4, 2018
PubMed

Insights

A 1:1 ratio of packed red blood cells to fresh frozen plasma (PRBC:FFP) best supports survival in pediatric trauma massive transfusion. Higher ratios increase mortality risk, indicating a need for more plasma products.

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.
Abstract

Keywords:
Pediatric massive transfusionTrauma resuscitation

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