Massive transfusion protocols in paediatric trauma population: A systematic review.

Area of Science:

• Pediatric Emergency Medicine
• Trauma Resuscitation
• Blood Transfusion Practices

Background:

• Paediatric massive transfusion (PMT) protocols are critical in managing severe hemorrhage in children.
• Existing literature lacks consensus on PMT definition, optimal blood product ratios, and overall outcomes.

Purpose of the Study:

• To review the literature and define paediatric massive transfusion (PMT).
• To identify investigated blood product ratios and their impact on paediatric outcomes.
• To evaluate existing evidence on PMT outcomes in children.

Main Methods:

• Systematic literature review following PRISMA guidelines.
• Searched multiple databases including PubMed, Google Scholar, and EMBASE.
• Included articles were assessed for study design, PMT definition, activation criteria, and transfusion ratios.

Main Results:

• 33 articles were included from 3213 initial searches.
• PMT definitions vary, primarily based on volume/kg but with differing timeframes.
• Some studies suggest improved paediatric mortality with balanced transfusion ratios (1:1 FFP:pRBC), but evidence is limited. PMT implementation did not consistently reduce paediatric trauma mortality but improved operational aspects like time to first transfusion.

Conclusions:

• A clear consensus on PMT definition is lacking; early recognition definitions show promise.
• Evidence for an optimal blood product ratio in PMT is insufficient, though balanced ratios appear favorable.
• PMT protocols have not consistently improved paediatric trauma mortality but may reduce morbidity and improve transfusion timeliness.