Massive transfusion in pediatric trauma: An ATOMAC perspective.

ABSTRACT

BACKGROUND/PURPOSE: Massive transfusion protocols (MTPs) are considered valuable in pediatric trauma. Important questions regarding the survival benefit and optimal blood component ratio remain unknown. METHODS: The study time frame was January 2007 through December 2013 five Level I Pediatric Trauma Centers reviewed all trauma activations involving children ≤18 years of age. Included were patients who either had the institutional MTP or received >20 mL/kg or > 2 units packed red blood cells (PRBCs). RESULTS: 110/202 qualified for inclusion. Median age was 5.9 years (3.0-11.4). 73% survived to discharge; median hospitalization was 10 (3.1-22.8) days. Survival did not vary by arrival hemoglobin (Hgb), gender or age. Partial prothrombin time (PTT), INR, GCS and injury severity score (ISS) significantly differed for nonsurvivors (all p < 0.05). Logistic regression found increased mortality (OR 3.08 (1.10-8.57), 95% CI; p = 0.031) per unit increase over a 11 ratio of pRBCFFP. CONCLUSION: In pediatric trauma pRBCFFP ratio of 11 was associated with the highest survival of severely injured children receiving massive transfusion. Ratios 21 or ≥31 were associated with significantly increased risk of death. These data support a higher proportion of plasma products for pediatric trauma patients requiring massive transfusion. LEVEL OF EVIDENCE Level IV.