Pediatric Massive Transfusion Protocol Dose Book: A Guide to Improve Balanced Ratios.

Area of Science:

• Pediatric Trauma Care
• Resuscitation Medicine
• Quality Improvement in Healthcare

Background:

• Pediatric massive transfusion protocol (MTP) activation is infrequent, posing challenges for maintaining clinician competency in high-risk scenarios.
• Ensuring balanced resuscitation during massive transfusion events in children is critical but often difficult to achieve.

Purpose of the Study:

• To assess the impact of a novel pediatric massive transfusion protocol dose book on packed red blood cell (PRBC) to plasma ratios.
• To evaluate the effectiveness of a weight-based dose book in guiding balanced resuscitation for pediatric trauma patients.

Main Methods:

• A 5-year pre-post quality improvement study at a pediatric Level I trauma center.
• Inclusion of trauma patients under 18 years receiving ≥40 mL/kg of blood products within 24 hours.
• Intervention: implementation of a weight-based dose book to guide PRBC and plasma administration.

Main Results:

• The average PRBC to plasma ratio improved from 3.38:1 pre-implementation to 1.37:1 post-implementation.
• This improvement was observed across 29 massive transfusion activations (14 pre, 15 post).

Conclusions:

• The pediatric massive transfusion protocol dose book effectively enhanced adherence to balanced blood product administration.
• This intervention demonstrates a successful strategy for improving outcomes in pediatric massive transfusion events.