title: Implementation of a pediatric trauma massive transfusion protocol: one institution's experience.
abstract: BACKGROUND
  Massive transfusion protocols (MTPs) with fixed ratios of blood products may improve outcomes in coagulopathic adult trauma patients. However, there is a paucity of data on transfusion support protocols for pediatric trauma patients, whose mechanisms of injury may differ from those seen in adults. We hypothesized that an MTP would improve outcomes in children, through a balanced blood product resuscitation.
  
  
  METHODS
  A pediatric trauma MTP, with a fixed ratio of red blood cells (RBCs):fresh-frozen plasma (FFP):platelets:cryoprecipitate in quantities based on the patient's weight, was initiated at a pediatric hospital. Data on clinical status, resuscitation volumes, and hospital course were collected and compared to data from pre-MTP trauma patients requiring transfusion.
  
  
  RESULTS
  Fifty-three patients were enrolled over a 15-month period and compared to 49 pre-MTP patients. Seventy-two percent of MTP patients had at least one coagulation value outside of the normal range upon emergency department (ED) arrival, and the median time to FFP transfusion decreased fourfold after MTP implementation (p<0.0001). A total of 49% of MTP patients received greater than 70 mL/kg blood products, and the 24-hour median FFP:RBC transfusion ratio was twofold higher in these patients than the pre-MTP cohort (median, 1:1.8 vs. 1:3.6; p=0.002). No improvement in mortality was observed after MTP implementation, taking into consideration injury severity, prothrombin time, and partial thromboplastin time.
  
  
  CONCLUSIONS
  A pediatric trauma MTP is feasible and allows for rapid provision of balanced blood products for transfusion to coagulopathic children. Larger studies are warranted to determine whether such protocols will improve outcomes for pediatric trauma patients.
authors: Aflac Cancer Center and Blood Disorders Service, Division of Pediatric Hematology/Oncology, and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA. jeanne.hendrickson@choa.org
authors: Jeanne E
authors: JE
authors: Hendrickson
authors: Beth H
authors: BH
authors: Shaz
authors: Greg
authors: G
authors: Pereira
authors: Paul M
authors: PM
authors: Parker
authors: Paula
authors: P
authors: Jessup
authors: Falisha
authors: F
authors: Atwell
authors: Beth
authors: B
authors: Polstra
authors: Elizabeth
authors: E
authors: Atkins
authors: Karen K
authors: KK
authors: Johnson
authors: Gaobin
authors: G
authors: Bao
authors: Kirk A
authors: KA
authors: Easley
authors: Cassandra D
authors: CD
authors: Josephson
mesh_terms: D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D001803:Blood Transfusion / Q000379:methods* / Q000401:mortality / Q000592:standards; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D006284:Health Plan Implementation / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D017713:Platelet Transfusion / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D065227:Transfusion Reaction; D014193:Trauma Centers / Q000592:standards; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*