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Examining 1:1 vs. 4:1 Packed Red Blood Cell to Fresh Frozen Plasma Ratio Transfusion During Pediatric Burn Excision
Shawn Tejiram1, Soman Sen1, Kathleen S Romanowski1
1Shriners Hospitals for Children Northern California and the Firefighters Burn Institute Regional Burn Center, Department of Surgery, University of California, Davis, Sacramento, California.
Insights
This study found no significant difference in outcomes for pediatric burn patients receiving a 1:1 or 4:1 packed red blood cell to fresh frozen plasma transfusion ratio. Infection rates and clinical outcomes were similar between the two massive transfusion strategies.
Area of Science:
- Pediatric Critical Care Medicine
- Burn Surgery
- Transfusion Medicine
Background:
- Blood transfusions are common in major pediatric burn injuries.
- Evidence supporting massive transfusion protocols in pediatric burn patients is limited compared to adults.
- Optimizing transfusion strategies is crucial for improving outcomes in critically ill children.
Purpose of the Study:
- To prospectively compare the outcomes of major pediatric burns treated with a 1:1 versus a 4:1 packed red blood cell (PRBC) to fresh frozen plasma (FFP) transfusion ratio during massive burn excision.
- To evaluate the impact of different PRBC:FFP ratios on infection rates and clinical outcomes in pediatric burn patients.
Main Methods:
- Prospective randomized study of children with >20% total body surface area burns undergoing massive burn excision.
- Patients were randomized to receive either a 1:1 or 4:1 PRBC:FFP transfusion ratio.
- Outcomes assessed included patient demographics, burn size, severity scores (PRISM, P-PODS), laboratory values, blood product usage, and incidence of bloodstream infections and pneumonia.
Main Results:
- No significant differences were observed in mean age, PRISM scores, estimated blood loss, ventilator days, or length of stay between the 1:1 and 4:1 groups.
- The frequency of bloodstream infections (20 vs. 18, P = 0.46) and pneumonia events (68 vs. 116, P = 0.08) did not differ significantly between the groups.
- Multivariate analysis identified total body surface area burn size, inhalation injury, and PRISM scores as significant predictors of infection (P < 0.05).
Conclusions:
- A 1:1 PRBC:FFP transfusion ratio is as effective as a 4:1 ratio in managing massive burn excisions in pediatric patients.
- Transfusion strategy (1:1 vs. 4:1 PRBC:FFP) does not appear to influence the incidence of bloodstream infections or pneumonia in this population.
- Burn size, inhalation injury, and initial severity scores are key factors associated with infection risk in pediatric burn patients.
Abstract:
Blood transfusions following major burn injury are common due to operative losses, blood sampling, and burn physiology. While massive transfusion improves outcomes in adult trauma patients, literature examining its effect in critically ill children is limited. The study purpose was to prospectively compare outcomes of major pediatric burns receiving a 1:1 vs. 4:1 packed red blood cell to fresh frozen plasma transfusion strategy during massive burn excision. Children with >20% total body surface area burns were randomized to a 1:1 or 4:1 packed red blood cell/fresh frozen plasma transfusion ratio during burn excision. Parameters examined include patient demographics, burn size, pediatric risk of mortality (PRISM) scores, pediatric logistic organ dysfunction scores, laboratory values, total blood products transfused, and the presence of blood stream infections or pneumonia. A total of 68 children who met inclusion criteria were randomized into two groups (n = 34). Mean age, PRISM scores, estimated blood loss (600 ml (400-1175 ml) vs. 600 ml (300-1150 ml), P = 0.68), ventilator days (5 vs. 9, P = 0.47), and length of stay (57 vs. 60 days, P = 0.24) had no difference. No differences in frequency of blood stream infection (20 vs. 18, P = 0.46) or pneumonia events (68 vs. 116, P = 0.08) were noted. On multivariate analysis, only total body surface area burn size, inhalation injury, and PRISM scores (P < 0.05) were significantly associated with infections.
