title: Prehospital use of blood and plasma in pediatric trauma patients.
abstract: OBJECTIVE
  Our rural trauma center uses packed red blood cells (PRBCs) and plasma onboard our helicopter to offset the delay of transport. We summarize our initial experience with prehospital blood use in pediatric trauma patients.
  
  
  METHODS
  Our air ambulance service began carrying PRBCs in 1987 and plasma in 2009. We performed a 9-year retrospective review including patients (< 18 years) who received blood during helicopter transports. Only patients transported to our level 1 trauma center were included to ensure complete follow-up.
  
  
  RESULTS
  Sixteen patients (6 females) were identified with a mean age of 13 years. The mean transport time was 30 minutes with 75% transferred in from a referring center. Injuries were blunt in 9 patients and penetrating in 2 patients. The mean Injury Severity Score was 30. Fifteen patients received an average of 1.5 units of PRBCs during flight. Indications for PRBCs were severe anemia (6), known blood loss (5), and nonresponder to intravenous fluids (4). Average hemoglobin improved from 9.4 to 11.4 mg/dL at our center. Base deficit improved from -7 to -5.7 at arrival. Five patients received a mean of 1.4 units of plasma. The arrival international normalized ratio was 1.4. The average length of stay was 9.3 days. Four patients died. Trauma Related Injury Severity Score showed 3 patients were unexpected survivors (0.24, 0.24, and 0.38).
  
  
  CONCLUSIONS
  Prehospital use of blood in injured children is rare. However, when indicated, this initial review of our protocol showed increased hemoglobin, decreased acidosis, and unexpected survivors with our program. Because of the rarity of prehospital blood use in children, administration triggers require continued review and refinement.
authors.affiliation: Division of Pediatric Surgery, University of Iowa, Iowa City, IA.
authors.forename: D Dean
authors.initials: DD
authors.lastname: Potter
authors.affiliation: Department of Surgery, Mayo Clinic Rochester, Rochester, MN; Mayo Clinic Medical Transport, Mayo Clinic Rochester, Rochester, MN.
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Berns
authors.affiliation: Department of Surgery, Mayo Clinic Rochester, Rochester, MN.
authors.forename: Terri A
authors.initials: TA
authors.lastname: Elsbernd
authors.affiliation: Department of Surgery, Mayo Clinic Rochester, Rochester, MN; Mayo Clinic Medical Transport, Mayo Clinic Rochester, Rochester, MN. Electronic address: zietlow.scott@mayo.edu.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Zietlow
mesh_terms: D000293:Adolescent; D017732:Air Ambulances / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000628:therapy*