Association of Blood Component Ratios With 24-Hour Mortality in Injured Children Receiving Massive Transfusion

Butler, Eric; Mills, Brianna; Arbabi, Saman; Bulger, Eileen M.; Vavilala, Monica S.; Groner, Jonathan I.; Stansbury, Lynn G.; Hess, John R.; Rivara, Frederick P.

doi:10.1097/ccm.0000000000003708

Cited by 55 publications

(74 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…may negatively impact patient outcomes. This point is supported by the findings of Butler et al, who reported a significantly higher risk of DVT when FFP:PRBC ratios of ≥2:1 were used 8. …”

supporting

confidence: 71%

“…Three of our six studies found significant improvement in paediatric mortality with high ratio blood products, but the definitions of "high ratio" differed among these studies (≥1:1 vs >1:2 FFP:pRBC), making it difficult to form general conclusions. [6][7][8] The remaining three studies also had different definitions of "high" vs "low" ratio transfusions, but none found a significant association of their high ratio transfusions with improved mortality outcomes. 4,5,9 Despite the lack of consensus, trauma centres have reported the use of specific blood ratio targets when treating paediatric trauma patients requiring MT.…”

Section: Investigation Of Various Blood Product Ratiosmentioning

confidence: 99%

“…4 Although adult MTPs using a both falling in the paediatric range). 2,[4][5][6][7][8][9][10] Despite this general understanding, existing evidence in support of PMT Protocols fail to reach consensus on the exact recommended blood component ratios to be administered in order to gain benefits. As trauma is the leading cause of mortality in children, the necessity for standardisation in the approach to PMT cannot be overstated.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Massive transfusion protocols in paediatric trauma population: A systematic review

Kinslow

McKenney

Boneva

et al. 2020

Transfusion Medicine

View full text Add to dashboard Cite

Background: Our main objective was to review the literature to answer the following questions regarding paediatric massive transfusion (PMT) protocols: (a) How is PMT defined?; (b) Which blood product ratios have been investigated, and what is their effect on outcomes?; and (c) What evidence exists regarding PMT outcomes? Methods: The PRISMA guidelines were used. We searched PubMed, Google Scholar, Cochrane Library, EMBASE, Wiley Online Library and Ovid. Articles were screened for inclusion based on relevance to PMT. Articles were assessed for study design, presence of established/tested PMT, PMT definition, PMT activation criteria and Transfusion Ratios for the final determination of article inclusion. Results: Our search produced 3213 articles, with 33 included for final review. Existing definitions of PMT are based on volume administered/kg but vary in timeframe criteria (over 4 hours vs 24 hours). Some studies have investigated "high" balanced transfusion ratios as seen in adults (1:1 FFP:pRBC), with a few showing statistically significant improvement in paediatric mortality vs lower ratios. PMT protocol implementation has not been shown to consistently reduce paediatric trauma mortality across multiple centres. However, other operational aspects, such as reduced time to first transfusion, are apparent benefits. Conclusions: There is poor consensus over the definition of PMT. Definitions that involve early recognition have the most promise for practice and future studies. Evidence supporting an optimal blood product ratio in PMT is also lacking but trends towards supporting balanced approaches. Implementation of PMT protocols has been limited in showing significant improvement of overall paediatric trauma mortality but may reduce associated morbidity.

show abstract

supporting

confidence: 71%

Section: Investigation Of Various Blood Product Ratiosmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Massive transfusion protocols in paediatric trauma population: A systematic review

Kinslow

McKenney

Boneva

et al. 2020

Transfusion Medicine

View full text Add to dashboard Cite

show abstract

“…The use of blood products for pediatric patients is complicated. The advantages of balanced resuscitation for hemorrhaging pediatric patients was shown to be associated with improved outcomes . Whole blood was shown to provide balanced resuscitation much more quickly at a civilian pediatric hospital compared to using components .…”

Section: Discussionmentioning

confidence: 99%

Early experience with transfusing low titer group O whole blood in the pre‐hospital setting in Israel

et al. 2020

View full text Add to dashboard Cite

BACKGROUND The Israeli Defense Force Medical Corps (IDF‐MC) recently implemented the use of low titer group O whole blood (LTOWB) in the airborne combat search and rescue unit (CSAR) for both military and civilian patients during transport to definitive care. LTOWB is preferentially used by the CSAR instead of red blood cell units and freeze‐dried plasma (FDP) for patients with signs of hemorrhagic shock. Ten percent of group O donors were eligible to donate LTOWB as they had anti‐A and ‐B IgM titers of <50. METHODS All patients treated by CSAR providers with LTOWB between July 2018 and June 2019 were included. RESULTS Between July 2018 and June 2019, eight patients have received 10 units of LTOWB. All patients suffered blunt injuries, 6 out of 8 (75%) of whom were due to motor vehicle accidents. Four patients (4 out of 8, 50%) received a single LTOWB unit, two patients (2 out of 8, 25%) received two units. Two pediatric patients received fewer than one unit of LTOWB. Median (range) heart rate was 130 (30‐150) bpm, median systolic blood pressure was 107 (80‐124) mmHg, and median Glasgow coma scale was 8 (on a scale of 3‐15). For four (4 out of 8, 50%) patients, LTOWB was the only blood product used for volume resuscitation. All six adult patients were treated with 1 g of tranexamic acid at the point of injury. CONCLUSIONS The CSAR has successfully implemented a LTOWB program for the pre‐hospital treatment of bleeding patients, and as its experience grows this product will be made available to other units and in civilian hospitals.

show abstract

“…However, Butler et al did find a small mortality benefit at 24 hours in pediatric patients who received higher ratios of plasma to PRBCs. 46 Despite the lack of quality evidence in children, balanced resuscitation remains a goal in the pediatric trauma population. 47 In adults, the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) advises the activation of an MT protocol when two out of the following four criteria are met: assessment of blood consumption (ABC) score (one point each for pulse > 120, systolic blood pressure < 90 mm Hg, positive focused assessment with sonography in trauma, or penetrating injury) of two or more, persistent hemodynamic instability, active bleeding requiring emergent intervention, and blood transfusion in the trauma bay.…”

Section: Massive Transfusion Protocols and Balanced Resuscitationmentioning

confidence: 99%

Trauma-Induced Coagulopathy in Children

Lucisano

Leeper

Gaines

2020

Semin Thromb Hemost

View full text Add to dashboard Cite

Trauma-induced coagulopathy (TIC) is well documented in injured children. However, many important features of pediatric hemostasis are still in development in early childhood and may impact TIC. Certain pediatric subgroups are at a higher risk. Traumatic brain injury, which occurs with a higher rate in children, and physical child abuse are known risk factors for TIC that deserve special consideration. Resuscitation of a pediatric trauma patient follows many of the same goals as in the injured adult trauma, although some key aspects of pediatric resuscitation require ongoing investigation. Venous thromboembolism occurs with higher rates in certain high-risk groups of pediatric trauma patients, although overall it is considerably less frequent in children as compared with adults.

show abstract

Association of Blood Component Ratios With 24-Hour Mortality in Injured Children Receiving Massive Transfusion

Abstract: Objective: To determine if higher fresh frozen plasma (FFP) and platelet to packed red blood cell (PRBC) ratios are associated with lower 24-hour mortality in bleeding pediatric trauma patients.

Cited by 55 publications

References 25 publications

Massive transfusion protocols in paediatric trauma population: A systematic review

Massive transfusion protocols in paediatric trauma population: A systematic review

Early experience with transfusing low titer group O whole blood in the pre‐hospital setting in Israel

Trauma-Induced Coagulopathy in Children

Contact Info

Product

Resources

About