LAUSR

Introduction/Hypothesis: Massive blood loss requires a large portion of a patient’s blood volume to be replaced rapidly. Blood product replacement in a near equivalent ratio has been associated with less coagulopathy and improved survival. Methods: We conducted a retrospective review of pediatric patients (0-21 years of age) requiring activation of a pediatric massive transfusion protocol (MTP) at a tertiary care children’s hospital over 30 months (February 2016-July 2018), following approval of the protocol in January 2016. The primary outcome measure was mortality. Secondary outcome measures included protocol adherence for product administration, identification of coagulopathy, and delayed protocol activation as a defined by greater than 3 packed red blood cell (PRBC) products in the 24-hour period prior to MTP activation. Results: Thirty-one patients met study criteria. Diagnostic indications for MTP activation were: cardiac (12/31, 39%), trauma (10/31, 32%), general surgery (5/31, 16%), and orthopedic (4/31, 13%). Nine patients required extracorporeal membrane oxygenation (29%). Mortality occurred in 13/31 (42%), most common with trauma (38%). In 13% (4/31) of MTP activations, ratio of PRBC: fresh frozen plasma product administration was ≥ 1:2 or 2:1 and 23% (7/31) did not receive any platelets. In the 24 hours prior to MTP activation, 17/31 (55%) of patients received >3 PRBC products. At least one coagulation test was abnormal (defined as INR ≥ 1.5, aPTT ≥ 45 seconds, platelet count < 100/μL) in 32% (10/31) in patients during protocol activation. Conclusions: Pediatric MTPs can be effective in aiding appropriate product repletion in a majority of cases. Delayed initiation of or failure to follow protocol may aggravate coagulopathy. Mortality is high if MTP is needed, although risk may be decreased with MTP adherence. Future research will evaluate factors associated with timely initiation of MTP and methods to maximize protocol adherence.