Team-Based Improvements in Pediatric Massive Transfusion Practice

Massive transfusion protocols (MTP) reduce morbidity and mortality in patients with life-threatening hemorrhage. However, in pediatric settings, MTP activations are rare, leading to inconsistent transfusion practices and underuse of adjunct therapies. We hypothesized that implementing a multidisciplinary MTP response team at our institution would be associated with improved adherence to best practice blood product ratios during pediatric MTP.

We conducted a retrospective cohort study of pediatric patients who underwent MTP activation at our tertiary pediatric hospital between March 2019 and February 2025. MTP activation was based on clinical judgment of expected transfusion >40 mL/kg. In May 2022, our hospital implemented an MTP response team composed of a trauma advanced practice provider, an emergency department nurse, and an emergency department critical care technician. This team responds to all MTP activations, coordinating with the blood bank and pharmacy to ensure timely administration of blood products and adjunct medications. We compared patients treated before (preimplementation) and after (post implementation) the team's initiation. The primary outcome was the proportion of patients receiving a balanced transfusion, defined as packed red blood cells to fresh frozen plasma ratio ≤1.4. Secondary outcomes included administration of adjunct medications and mortality.

Ninety-four MTP activations met inclusion criteria (16 preimplementation and 78 post implementation). Patients in the post implementation group were significantly more likely to receive a balanced transfusion (n = 41, 53%, P < 0.001) and tranexamic acid (n = 52, 67%, P < 0.001).

The implementation of a dedicated, multidisciplinary MTP response team was associated with increased adherence to evidence-based transfusion practices in pediatric patients undergoing MTP.