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Team-Based Improvements in Pediatric Massive Transfusion Practice.

Sommer L Glasgow1, Anastasia M Kahan1, Christopher Clinker1

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|April 4, 2026
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Summary
This summary is machine-generated.

Implementing a multidisciplinary Massive Transfusion Protocol (MTP) response team improved adherence to best practices for pediatric MTP. This led to more balanced blood product ratios and increased use of adjunct therapies in critically ill children.

Keywords:
Balanced transfusionMassive transfusion protocol (MTP)Multidisciplinary response teamPediatric massive transfusionQuality improvement

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Area of Science:

  • Pediatric critical care medicine
  • Hemorrhage management
  • Transfusion medicine

Background:

  • Massive Transfusion Protocols (MTP) are vital for managing life-threatening hemorrhage, reducing patient morbidity and mortality.
  • Pediatric MTP activations are infrequent, often resulting in inconsistent transfusion practices and suboptimal use of adjunct therapies.
  • A multidisciplinary MTP response team may enhance adherence to evidence-based transfusion guidelines in pediatric settings.

Purpose of the Study:

  • To evaluate the impact of a multidisciplinary MTP response team on transfusion practices in pediatric patients.
  • To assess adherence to balanced blood product ratios and the use of adjunct medications post-implementation.
  • To determine if the MTP response team influences patient outcomes, including mortality.

Main Methods:

  • Retrospective cohort study of pediatric patients undergoing MTP activation (March 2019-February 2025) at a tertiary pediatric hospital.
  • Comparison of transfusion practices before (pre-implementation) and after (post-implementation) the initiation of a dedicated MTP response team in May 2022.
  • Primary outcome: proportion of patients receiving a balanced transfusion (PRBC:FFP ratio ≤1.4). Secondary outcomes: adjunct medication administration and mortality.

Main Results:

  • Seventy-eight MTP activations occurred post-implementation compared to 16 pre-implementation.
  • Patients receiving care post-implementation were significantly more likely to receive a balanced transfusion (53% vs. pre-implementation, P < 0.001).
  • Administration of tranexamic acid also significantly increased post-implementation (67% vs. pre-implementation, P < 0.001).

Conclusions:

  • The implementation of a dedicated, multidisciplinary MTP response team significantly improved adherence to evidence-based transfusion practices in pediatric patients.
  • This initiative led to more consistent and appropriate use of blood products and adjunct therapies during MTP activations.
  • The findings support the integration of specialized teams to optimize MTP management in pediatric critical care.