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Integrated Compensatory Responses in a Human Model of Hemorrhage
Published on: November 20, 2016
Balanced hemostatic resuscitation for bleeding pediatric trauma patients: A nationwide quantitative analysis of
Malak Akl1, Tanya Anand1, Raul Reina1
1Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ 85724, USA.
Insights
A 1:1 ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) improves survival in pediatric trauma patients. This transfusion strategy is associated with lower mortality and reduced PRBC requirements in children.
Area of Science:
- Trauma Care
- Pediatric Critical Care
- Transfusion Medicine
Background:
- Balanced component therapy improves outcomes in adult trauma patients.
- Limited data exists on optimal transfusion ratios for pediatric trauma.
- This study aims to compare outcomes based on different transfusion strategies in children.
Purpose of the Study:
- To compare outcomes among pediatric trauma patients receiving different fresh frozen plasma (FFP) to packed red blood cell (PRBC) transfusion ratios.
- To identify the optimal FFP:PRBC ratio for improving survival in pediatric trauma.
Main Methods:
- Retrospective analysis of the Trauma Quality Improvement Program (2014-2016).
- Included pediatric trauma patients (<18 years) receiving PRBC and FFP within 4 hours of admission.
- Patients stratified into FFP:PRBC ratio groups: 1:1, 1:2, 1:3, and 1:3+; primary outcomes were 24-hour and in-hospital mortality.
Main Results:
- The 1:1 FFP:PRBC ratio group showed significantly lower 24-hour mortality (14%) and in-hospital mortality (32%) compared to other ratios.
- No significant differences in complications like ARDS or AKI were observed across groups.
- The 1:1 group required fewer PRBC transfusions, indicating more efficient resuscitation.
Conclusions:
- FFP:PRBC ratios closest to 1:1 are associated with increased survival in pediatric trauma patients.
- Resuscitation protocols for pediatric trauma should target a 1:1 FFP:PRBC ratio.
- Further research is needed to develop specific massive transfusion protocols for this age group.
Background:
The administration of balanced component therapy has been associated with improvements in outcomes in adult trauma. There is little to no specific data to guide transfusion ratios in children. The aim of our study is to compare outcomes among different transfusion strategies in pediatric trauma patients.
Methods:
We conducted a (2014-2016) retrospective analysis of the Trauma Quality Improvement Program. We selected all pediatric (age < 18) trauma patients who received at least one unit of packed red blood cells (PRBC) and fresh frozen plasma (FFP) within 4 h of admission. Patients were stratified based on their FFP:PRBC transfusion ratio in the first 4 h into: 1:1, 1:2, 1:3, and 1:3+. Primary outcomes were 24-mortality, in-hospital mortality. Secondary outcomes were complications and 24 h PRBC transfusion requirements. Multivariable logistic regression analysis was performed.
Results:
A total of 1,233 patients were identified of which 637 received transfusion ratio of 1:1, 365 1:2, 116 1:3, and 115 1:3+. Mean age was 11 ± 6y, 70% were male, ISS was 27 [20-38], and 62% sustained penetrating injuries. Patients in the 1:1 group had the lowest 24 h mortality (14% vs. 18% vs. 22% vs. 24%; p = 0.01) and in-hospital mortality (32% vs. 36% vs. 40% vs. 44%; p = 0.01). No difference was found between the groups in terms of complications (22% vs. 21% vs. 23% vs. 22%; p = 0.96) such as acute respiratory distress syndrome (3.3% vs. 3.6% vs. 0.9% vs. 0%; p = 0.10), and acute kidney injury (3% vs. 2.2% vs. 0.9% vs. 0.9%; p = 0.46). Additionally the 1:1 group had the lowest PRBC transfusion requirements (3[2-7] vs. 5[2-10] vs. 6[3-8] vs. 6[4-10]; p < 0.01). On regression analysis a progressive increase in the mortality adjusted odds ratio was observed as the FFP:PRBC transfusion ratio decreased.
Conclusion:
FFP:PRBC ratios closest to 1 were associated with increased survival in children. The resuscitation of pediatric patients should target a 1:1 ratio of FFP:PRBC. Further studies are needed for the development of massive transfusion protocols for this age group.
Level Of Evidence:
Level IV STUDY TYPE: Therapeutic/Care Management.
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