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Pediatric Massive Transfusion Protocol Dose Book: A Guide to Improve Balanced Ratios
Tiffany L Taylor1, Joshua Dugal, Steven P Laffey
1Author Affiliations: Trauma Program Manager, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri (Ms Taylor); Senior Director of Trauma and Burn Services, Regional One Health Elvis Presley Trauma Center, Memphis, Tennessee (Mr Dugal); Division of Pediatric Emergency Medicine, St. Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri (Dr Laffey); Section of Emergency Medicine, Children's Hospital Colorado Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado (Dr Spencer); and Division of Critical Care Medicine, Department of Pediatrics Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri (Dr Thompson).
Background:
Pediatric massive transfusion protocol activation is rare, even in high-volume trauma centers. Maintaining competency in these low-frequency, high-risk events is challenging and often impedes balanced resuscitation.
Objective:
This project aims to evaluate the effectiveness of a pediatric massive transfusion protocol dose book in improving packed red blood cell to plasma ratios during massive transfusion events.
Methods:
This pre-post quality improvement study was conducted over 5 years (June 2019-March 2024) at an urban Midwestern U.S. pediatric Level I trauma center. Inclusion criteria were trauma patients under 18 years who received ≥40 mL/kg of blood products within the first 24 hours. The intervention was a novel weight-based dose book designed to guide balanced resuscitation. The primary outcome was adherence to a 1:1 packed red blood cell to plasma ratio.
Results:
Among 29 massive transfusion activations, the average packed red blood cell-to-plasma ratio improved from 3.38:1 (preimplementation) (n = 14) to 1.37:1 (postimplementation) (n = 15).
Conclusion:
Implementing a pediatric massive transfusion protocol dose book improved adherence to balanced blood product administration during massive transfusion events.
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