The impact of blood product ratios in massively transfused pediatric trauma patients

Nosanov, Lauren B; Inaba, Kenji; Okoye, Obi; Resnick, Shelby; Upperman, Jeffrey S.; Shulman, Ira A.; Rhee, Peter; Δημητριάδης, Δημήτριος

doi:10.1016/j.amjsurg.2013.07.009

Cited by 79 publications

(62 citation statements)

References 22 publications

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“…[1] Red blood cell (RBC) transfusions can play a lifesaving role in these patients, but doctors are often reluctant to administer blood transfusions to children because of potential complications. In a prospective study involving adult trauma patients, Malone et al [2] demonstrated that receiving a blood transfusion is one of the predic tors of mortality.…”

Section: Researchmentioning

confidence: 99%

A review of blood transfusions in a trauma unit for young children

et al. 2017

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Section: Researchmentioning

confidence: 99%

A review of blood transfusions in a trauma unit for young children

et al. 2017

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“…Importantly, despite utilizing a MTP, neither study was able to reach the protocols’ goal of 1:1 ratio for FFP:RBC transfusion due to the lack of availability of thawed plasma. Recently a retrospective study on 105 pediatric trauma patients receiving massive transfusion found no association between blood product ratios and survival [114]. Interestingly, all casualities suffered from severe TBI (head AIS ≥ 3) and not hemorrhage.…”

Section: Transfusion Of Blood and Plasmamentioning

confidence: 99%

Coagulopathy After Severe Pediatric Trauma

Christiaans¹,

Duhachek-Stapelman

Russell

et al. 2014

Shock

106

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Trauma remains the leading cause of morbidity and mortality in the United States among children from the age 1 year to 21 years old. The most common cause of lethality in pediatric trauma is traumatic brain injury (TBI). Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy (TIC) include hypothermia, acidosis, hemodilution and consumption of coagulation factors secondary to local activation of the coagulation system following severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of TIC that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma.

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“…MTPs that provide blood products in fixed amounts, adjusted for weight‐based transfusion volumes, have also been implemented for pediatric trauma patients . However, MTP implementation and higher plasma‐ and PLT‐to‐RBC ratios in pediatric trauma patients have not been associated with improved outcomes or survival …”

mentioning

confidence: 99%

International assessment of massive transfusion protocol contents and indications for activation

Investigators

2019

Transfusion

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BACKGROUND Massive transfusion protocols (MTPs) provide blood products rapidly and in fixed amounts. MTPs are commonly used in trauma but may also be used in other clinical settings, although evidence to support fixed‐ratio resuscitation in nontraumatic hemorrhage is lacking. The goals of this study were to describe the types and contents of available MTPs and the clinical indications for MTP activation. METHODS A survey was distributed to 353 transfusion medicine specialists to assess the types and contents of available MTPs. Survey participants were invited to provide the clinical indications for consecutive adult and pediatric MTP activations for at least 6 months during 2015 to 2017. RESULTS There were 125 completed surveys (35% response rate) including three from children's specialty hospitals. Most hospitals that treated adult patients (90/122, 74%) utilized only one MTP for all adult bleeding emergencies, while one hospital had no MTP. Of the 31 hospitals that provided more than one adult MTP, 20 provided MTPs specific for obstetric bleeding cases. Of these, 50% (10/20) included at least one pool of cryoprecipitate or fibrinogen concentrate in the first MTP round, compared with 14% (13/90) of the hospitals with one MTP (p = 0.0012). Fifty‐seven hospitals provided the clinical indication for 4176 adult and 155 pediatric MTP activations. Although trauma was the single most common indication, the majority of adult (58%) and pediatric (65%) activations were for nontrauma indications. CONCLUSIONS The majority of hospitals use a single MTP to manage massive hemorrhage. The majority of MTP activations were for nontrauma indications.

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The impact of blood product ratios in massively transfused pediatric trauma patients

Cited by 79 publications

References 22 publications

A review of blood transfusions in a trauma unit for young children

A review of blood transfusions in a trauma unit for young children

Coagulopathy After Severe Pediatric Trauma

International assessment of massive transfusion protocol contents and indications for activation

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