High ratio plasma resuscitation does not improve survival in pediatric trauma patients

Cannon, Jeremy W.; Johnson, Michael; Caskey, Robert C.; Borgman, Matthew A.; Neff, Lucas P.

doi:10.1097/ta.0000000000001549

Cited by 56 publications

(66 citation statements)

References 43 publications

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“…However, this approach cannot be generalized to all bleeding patients needing transfusion. Paediatric trauma patients do not seem to benefit from any particular resuscitation ratio in the first 24 h, and patients undergoing nonmassive transfusion support demonstrated no clinical advantages associated with the use of high plasma ratios .…”

Section: Introductionmentioning

confidence: 98%

A high plasma: red blood cell transfusion ratio during liver transplantation is associated with decreased blood utilization

et al. 2018

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Section: Introductionmentioning

confidence: 98%

A high plasma: red blood cell transfusion ratio during liver transplantation is associated with decreased blood utilization

et al. 2018

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“…With an average fibrinogen concentration of 2 g/L, the volumes required to match fibrinogen need are prohibitive in some cases and may contribute to its dilution . FFP has shown no survival advantage when used in increased transfusion ratios in paediatric MHP and adverse events have been related to its use . FFP has been associated with increased incidence of new or progressive MODS, increased rates of nosocomial infections and longer intensive care unit stays in critically ill children …”

Section: Methodsmentioning

confidence: 99%

Viscoelastic haemostatic assays and fibrinogen in paediatric acute traumatic coagulopathy: A comprehensive review

Maconachie

Jansen

Cottle

et al. 2020

Emerg Medicine Australasia

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Objective Haemorrhage in paediatric trauma remains a significant cause of morbidity and mortality. Over recent years there has been increasing attention to the role of fibrinogen in traumatic haemorrhage and the association of low fibrinogen levels with poor patient outcomes. In addition, there has been a move towards using viscoelastic haemostatic assays (VHAs) to rapidly assess coagulation status and guide clinicians in the replacement of coagulation factors, including fibrinogen. In the paediatric population, there has been limited uptake of these principles and a paucity of data to support a change in practice. This paper summarises the available evidence in the published literature through a systematic review, presented in narrative format. Results There is limited high‐quality prospective data on the use of VHA in the management of acute traumatic coagulopathy in the paediatric population. While the use of fibrinogen early in major haemorrhage is becoming standard practice, there are currently no randomised prospective studies comparing fibrinogen concentrate to cryoprecipitate. Conclusions The early identification of hypo‐fibrinogenemia and acute traumatic coagulopathy in paediatric trauma using VHA testing and subsequent early fibrinogen replacement with a concentrated off the shelf product is an attractive treatment option. However, there is currently insufficient high‐level evidence to support the use of fibrinogen concentrate over cryoprecipitate in the paediatric trauma population. Pilot studies currently under way will go some way to addressing this important knowledge gap, and facilitate the design of larger definitive multi‐centre randomised trials.

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“…In contrast, we have only insufficient evidence on efficacy of P-MTP although many authors had tried to prove it (Table 3) 17,[37][38][39][40][41][42][43][44] . The lack of proven survival benefit might be associated with low achievement rates of a 1:1 FFP:PRBC ratio (25%-37%) 17,39,43,44) and high TBI rates (30%-71%) 17,37,[39][40][41]43,44) (Table 3).…”

Section: ) Evidence For P-mtpmentioning

confidence: 97%

“…Also, it might stem from the inherent difficulties of study on critically injured children, such as the low incidence of events and ethical problems in obtaining informed consent. With the insufficient evidence, P-MTPs are performed largely based on extrapolation from adult studies as manifested by the higher median age of children receiving higher FFP:PRBC ratio (9-11 [≥ 1:2] vs. 4-7 years [< 1:2]) 42,43) .…”

Section: ) Evidence For P-mtpmentioning

confidence: 99%

“…Recent literature about P-MTP has added evidence on increasing use of FFP, and its efficacy for hemostasis and survival ( Table 3). Implementation of P-MTP is associated with a decrease in use of PRBC and an increase in use of FFP and PLT 40,42) . A single center study reported the absence of hemorrhagic deaths in 105 children undergoing P-MTP (mortality rate, 18.1%; all by TBI) 39) .…”

Section: ) Evidence For P-mtpmentioning

confidence: 99%

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Damage control resuscitation in children

Kim¹,

Ko²,

Jung³

2019

Pediatr Emerg Med J

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Damage control resuscitation is a relatively new resuscitative strategy for patients with severe traumatic hemorrhage. This strategy consists of permissive hypotension and early balanced transfusion, and transfers the patients to subsequent surgery. There is growing evidence on harms of excessive fluids. Since 2013, survival benefit of massive transfusion protocol has been proven in adults. Despite insufficient evidence, pediatric massive transfusion protocols are widely used in North American trauma centers. This review focuses on the concept of damage control resuscitation, and summarizes the relevant pediatric evidence.

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High ratio plasma resuscitation does not improve survival in pediatric trauma patients

Abstract: Therapeutic study, level III.

Cited by 56 publications

References 43 publications

A high plasma: red blood cell transfusion ratio during liver transplantation is associated with decreased blood utilization

A high plasma: red blood cell transfusion ratio during liver transplantation is associated with decreased blood utilization

Viscoelastic haemostatic assays and fibrinogen in paediatric acute traumatic coagulopathy: A comprehensive review

Damage control resuscitation in children

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