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Survey of pediatric massive transfusion protocol practice at United States level I trauma centers: An AABB Pediatric
Brian D Adkins1,2, Daniel K Noland1,2, Jeremy W Jacobs3
1Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Pediatric massive transfusion protocols (MTPs) show similar practices nationwide. While fibrinogen is common, newer strategies like antifibrinolytic therapy and routine viscoelastic testing are infrequent in pediatric trauma resuscitation.
Area of Science:
- Pediatric Trauma Care
- Transfusion Medicine
- Resuscitation Strategies
Background:
- Trauma is the leading cause of death in US children.
- Optimal pediatric resuscitation strategies using massive transfusion protocols (MTPs) are not well-defined.
- Current MTP practices in pediatric trauma centers require assessment.
Purpose of the Study:
- To evaluate contemporary practices of massive transfusion protocols (MTPs) in pediatric trauma patients across the United States.
- To understand the implementation and recent changes in MTP policies.
- To identify variations and commonalities in MTP application.
Main Methods:
- A web-based survey was distributed to verified pediatric trauma centers by the Association for the Advancement of Blood & Biotherapies (AABB).
- The survey collected data on current MTP policies, implementation details, and practice modifications.
- Data analysis focused on transfusion ratios, adjunctive therapies, and diagnostic tool utilization.
Main Results:
- A 55% response rate was achieved from pediatric trauma centers, primarily located in the South.
- The median red blood cell (RBC) to plasma ratio was 1:1.
- Fibrinogen supplementation was frequently used, but antifibrinolytic therapy and routine viscoelastic testing (VET) were uncommon.
Conclusions:
- Massive transfusion protocol (MTP) practices are largely uniform across US pediatric trauma centers.
- While fibrinogen use is prevalent, advanced interventions like antifibrinolytic therapy and routine VET are not widely adopted.
- Continued monitoring of practice changes is crucial as new resuscitation modalities emerge for pediatric trauma patients.
Background:
Trauma remains the leading cause of pediatric mortality in the United States. Although use of massive transfusion protocols (MTPs) in this population is widespread, optimal pediatric resuscitation is not well established. We sought to assess contemporary pediatric MTP practice in the United States.
Study Design And Methods:
A web-based survey was designed by the Association for the Advancement of Blood & Biotherapies (AABB) Pediatric Transfusion Medicine Subsection and distributed to select American College of Surgeons (ACS) Level I Verified pediatric trauma centers. The survey assessed current MTP policy, implementation, and recent changes in practice.
Results:
Response rate was 55% (22/40). Almost half of the respondents were from the South. The median RBC:plasma ratio was 1 (interquartile range 1-1.5). Protocolized fibrinogen supplementation was common while integration of antifibrinolytic therapy into MTPs was infrequent. Viscoelastic testing (VET) was available at most sites, 71% (15/21, one site did not respond), and was generally utilized on an ad-hoc basis. Roughly, a third of sites had changed their MTP in the past 3 years due to blood supply issues, and about a third reported having group O Whole Blood on-site.
Conclusion:
MTP practice is similar throughout the United States. Though fibrinogen supplementation is common-other emerging interventions such as antifibrinolytic therapy or utilization of routine viscoelastic testing-are not widespread. Pediatric transfusion medicine experts must continue to follow practice change, as contemporary large trials begin to characterize new supportive modalities to optimize resuscitation in pediatric trauma patients.
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