Author:
Mehl Steven C.,Vogel Adam M.,Glasgow Amy E.,Moody Suzanne,Kotagal Meera,Williams Regan F.,Kayton Mark L.,Alberto Emily C.,Burd Randall S.,Schroeppel Thomas J.,Baerg Joanne E.,Munoz Amanda,Rothstein William B.,Boomer Laura A.,Campion Eric M.,Robinson Caitlin,Nygaard Rachel M.,Richardson Chad J.,Garcia Denise I.,Streck Christian J.,Gaffley Michaela,Petty John K.,Greenwell Cynthia,Pandya Samir,Waters Alicia M.,Russell Robert T.,Yorkgitis Brian K.,Mull Jennifer,Pence Jeffrey,Santore Matthew T.,MacArthur Taleen A.,Klinkner Denise B.,Safford Shawn D.,Trevilian Tanya,Cunningham Megan,Black Christa,Rea Jessica,Spurrier Ryan G.,Jensen Aaron R.,Farr Bethany J.,Mooney David P.,Ketha Bavana,Dassinger Melvin S.,Goldenberg-Sandau Anna,Roman Janika San,Jenkins Todd M.,Falcone Richard A.,Polites Stephanie
Abstract
BACKGROUND
The benefit of targeting high ratio fresh frozen plasma (FFP)/red blood cell (RBC) transfusion in pediatric trauma resuscitation is unclear as existing studies are limited to patients who retrospectively met criteria for massive transfusion. The purpose of this study is to evaluate the use of high ratio FFP/RBC transfusion and the association with outcomes in children presenting in shock.
METHODS
A post hoc analysis of a 24-institution prospective observational study (April 2018 to September 2019) of injured children younger than 18 years with elevated age-adjusted shock index was performed. Patients transfused within 24 hours were stratified into cohorts of low (<1:2) or high (≥1:2) ratio FFP/RBC. Nonparametric Kruskal-Wallis and χ2 were used to compare characteristics and mortality. Competing risks analysis was used to compare extended (≥75th percentile) ventilator, intensive care, and hospital days while accounting for early deaths.
RESULTS
Of 135 children with median (interquartile range) age 10 (5–14) years and weight 40 (20–64) kg, 85 (63%) received low ratio transfusion and 50 (37%) high ratio despite similar activation of institutional massive transfusion protocols (low–38%, high–46%, p = 0.34). Most patients sustained blunt injuries (70%). Median injury severity score was greater in high ratio patients (low–25, high–33, p = 0.01); however, hospital mortality was similar (low–24%, high–20%, p = 0.65) as was the risk of extended ventilator, intensive care unit, and hospital days (all p > 0.05).
CONCLUSION
Despite increased injury severity, patients who received a high ratio of FFP/RBC had comparable rates of mortality. These data suggest high ratio FFP/RBC resuscitation is not associated with worst outcomes in children who present in shock. Massive transfusion protocol activation was not associated with receipt of high ratio transfusion, suggesting variability in MTP between centers.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Publisher
Ovid Technologies (Wolters Kluwer Health)