Use of a massive transfusion protocol with hemostatic resuscitation for severe intraoperative bleeding in a child

Dressler, Alex M.; Finck, Christine; Carroll, Christopher L.; Bonanni, Craig; Spinella, Philip C.

doi:10.1016/j.jpedsurg.2010.03.023

Cited by 39 publications

(19 citation statements)

References 15 publications

(19 reference statements)

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“…Several studies have attempted to examine this issue but were unable to draw definitive conclusions. 16,17 Data in the adult population have shown decreased mortality with high FFP/PRBC ratios; 1–5 however, one study in the pediatric population has documented an increased incidence of multiorgan system failure with increasing units of FFP transfused in pediatric liver transplant patients. 18 …”

Section: Discussionmentioning

confidence: 99%

A pediatric massive transfusion protocol

Chidester

Williams

Wang

et al. 2012

Journal of Trauma and Acute Care Surgery

105

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BACKGROUND Pediatric massive blood transfusions occur widely at hospitals across the nation; however, there are limited data on pediatric massive transfusion protocols (MTPs) and their impact. We present a pediatric MTP and examine its impact on morbidity and mortality as well as identify factors that may prompt protocol initiation. METHODS Using a prospective cohort, we collected data on all pediatric patients who required un–cross-matched blood from January 1, 2009, through January 1, 2011. This captured patients who received blood products according to the protocol as well as patients who were massively transfused at physician discretion. Outcomes between groups were compared. RESULTS A total of 55 patients received un–cross-matched blood, with 22 patients in the MTP group and 33 patients receiving blood at physician discretion (non–MTP group). Mortality was not significantly different between groups. Injury Severity Score for the MTP group was 42 versus 25 for the non–MTP group (p ≤ 0.01). Thromboembolic complications occurred more exclusively in the non–MTP group (p ≤ 0.04). Coagulopathy, evidenced by partial thromboplastin time (PTT) greater than 36, was associated with initiation of the MTP. CONCLUSION MTPs have been widely adopted by hospitals to minimize the coagulopathy associated with hemorrhage. Blood transfusion via MTP was associated with fewer thromboembolic events. Coagulopathy was associated with initiation of the MTP. These results support the institution of pediatric MTPs and suggest a need for further research on the protective relationship between MTP and thromboembolic events and on identifying objective factors associated with MTP initiation. LEVEL OF EVIDENCE Therapeutic study, level IV.

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Section: Discussionmentioning

confidence: 99%

A pediatric massive transfusion protocol

Chidester

Williams

Wang

et al. 2012

Journal of Trauma and Acute Care Surgery

105

View full text Add to dashboard Cite

show abstract

“…Along with these retrospective studies, several prospective observational studies have sought to further refine current trauma transfusion practices [27]. The widespread and enthusiastic adoption of Bbalance resuscitation^practices in the adult population has translated into changes in pediatric care as well [28][29][30][31][32][33]. This shift in balanced resuscitation for injured children, however, has not been thoroughly studied due to the relative infrequency of massive transfusions in children.…”

Section: Blood Transfusionmentioning

confidence: 99%

“…Large, prospective observation studies of injured children requiring massive transfusion are currently ongoing and will provide greater insight on optimization of blood product administration. Until further information does come to light, the presumed benefits of balanced blood product administration have led many US pediatric trauma centers to adopt modified versions of adult massive transfusion protocols [30,32,33].…”

Section: Blood Transfusionmentioning

confidence: 99%

Pediatric Combat Trauma

Russo

Neff

2016

Curr Trauma Rep

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Purpose of review Military physicians have amassed tremendous experience treating children with combat-related injuries in Iraq and Afghanistan. This review will present several treatment principles adapted from adult trauma care that were applied to children in war and consider their selective application in civilian practice. Recent findings Many standard practices of adult trauma care were applied to the management of war-injured children. Initial reports of tourniquet use, tranexamic acid administration, and balanced blood transfusion suggest a benefit to the pediatric population. Constraints of providing intensive care in an austere environment required a shift in management toward aggressive limb salvage over amputation, and early palliation for severe brain injury or extensive burns.Summary Despite the obstacles that may limit the direct translation of trauma care principals to civilian settings, these wartime experiences offer robust and excellent preliminary data that might inform future investigations in the field of pediatric trauma care.

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“…6 In addition, massive transfusion protocols with balanced blood component replacement paradigms have now been extrapolated from our military's recent wars into pediatric surgical resuscitation practices with good effect. 30 Patients leaving the operating room with coagulation parameters substantially different from their outpatient baselineV whether secondary to hemodilution or underresuscitationVwere almost expected to require further blood component transfusions within 48 hours.…”

Section: Discussionmentioning

confidence: 99%