Patterns of paediatric massive blood transfusion protocol use in trauma and non-trauma patients.

Autor: Alberto EC; Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia, USA., Zheng Y; Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia, USA., Milestone ZP; Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia, USA., Cheng M; Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia, USA., Ahmed OZ; Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia, USA., Olafson S; Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia, USA., Fritzeen JL; Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia, USA., Sharron MP; Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA., Burd RS; Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia, USA., Jacquot C; Departments of Laboratory Medicine and Hematology, Children's National Hospital, Washington, District of Columbia, USA.
Jazyk: angličtina
Zdroj: Transfusion medicine (Oxford, England) [Transfus Med] 2021 Dec; Vol. 31 (6), pp. 439-446. Date of Electronic Publication: 2021 Oct 27.
DOI: 10.1111/tme.12829
Abstrakt: Background: Massive blood transfusion is infrequently required by children but can be a lifesaving intervention for haemorrhage or coagulopathy. Product volumes and ratios administered during the initiation of paediatric massive blood transfusion protocol (MBTP) are highly variable and the optimal component ratio is unknown.
Methods/materials: We performed a single-centre retrospective chart review of patients (<20 years) who received MBTP activation from August 2012 through January 2018. Logistic regression was used to determine the association between MBTP use characteristics (including blood product type and volume transfused, extracorporeal membrane oxygenation [ECMO] support, and cardiac arrest occurrence) and 24-h mortality. "Low" product ratio was defined as a ratio of plasma or platelets to red blood cells (RBCs) of <1:2 and "high" as ≥1:2.
Results: Ninety-eight MBTPs were activated for 89 patients (range 1-4 per patient). The most common underlying diagnoses were congenital heart disease (CHD, n = 28, 31.5%), followed by cardiopulmonary disease, and trauma. CHD patients required the greatest volume of RBCs (226.3 ml/kg, 95%CI [160.0, 292.7], p = 0.002) and platelets (46.7 ml/kg, 95%CI [33.2, 60.2], p < 0.001). A "low" product ratio was more common for the MBTP, with its incidence similar among the underlying diagnoses.
Conclusion: An MBTP developed for trauma patients can be applied to non-trauma patients but standard MBTP components may not be optimal for all children. These findings show that underlying patient diagnoses may be a factor when designing an MBTP for a heterogeneous paediatric population.
(© 2021 British Blood Transfusion Society.)
Databáze: MEDLINE
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