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Team-Based Improvements in Pediatric Massive Transfusion Practice
Sommer L Glasgow1, Anastasia M Kahan1, Christopher Clinker1
1Division of Pediatric Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.
Insights
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.
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.
Introduction:
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.
Methods:
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.
Results:
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).
Conclusions:
The implementation of a dedicated, multidisciplinary MTP response team was associated with increased adherence to evidence-based transfusion practices in pediatric patients undergoing MTP.
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