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Observational Study
. 2022 Apr 1;23(4):235-244.
doi: 10.1097/PCC.0000000000002907. Epub 2022 Feb 28.

Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding

Philip C Spinella  1 , Julie C Leonard  2 , Callie Marshall  3 , James F Luther  4 , Stephen R Wisniewski  4 , Cassandra D Josephson  5 , Christine M Leeper  1 ; Massive Transfusion In Children (MATIC) Investigators and BloodNet
Affiliations
Observational Study

Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding

Philip C Spinella et al. Pediatr Crit Care Med. .

Abstract

Objectives: To assess the impact of plasma and platelet ratios and deficits in injured children with life-threatening bleeding.

Design: Secondary analysis of the MAssive Transfusion epidemiology and outcomes In Children study dataset, a prospective observational study of children with life-threatening bleeding events.

Setting: Twenty-four childrens hospitals in the United States, Canada, and Italy.

Patients: Injured children 0-17 years old who received greater than 40 mL/kg total blood products over 6 hours or were transfused under activation of massive transfusion protocol.

Intervention/exposure: Weight-adjusted blood product volumes received during the bleeding event were recorded. Plasma:RBC ratio (plasma/RBC weight-adjusted volume in mL/kg) and platelet:RBC ratio (platelet/RBC weight-adjusted volume in mL/kg) were analyzed. Plasma deficit was calculated as RBC mL/kg - plasma mL/kg; platelet deficit was calculated as RBC mL/kg - platelet mL/kg.

Measurements and main results: Of 191 patients analyzed, median (interquartile range) age was 10 years (5-15 yr), 61% were male, 61% blunt mechanism, and median (interquartile range) Injury Severity Score was 29 (24-38). After adjusting for Pediatric Risk of Mortality score, cardiac arrest, use of vasoactive medications, and blunt mechanism, a high plasma:RBC ratio (> 1:2) was associated with improved 6-hour survival compared with a low plasma:RBC ratio (odds ratio [95% CI] = 0.12 [0.03-0.52]; p = 0.004). Platelet:RBC ratio was not associated with survival. After adjusting for age, Pediatric Risk of Mortality score, cardiac arrest, and mechanism of injury, 6-hour and 24-hour mortality were increased in children with greater plasma deficits (10% and 20% increased odds of mortality for every 10 mL/kg plasma deficit at 6 hr [p = 0.04] and 24 hr [p = 0.01], respectively); 24-hour mortality was increased in children with greater platelet deficits (10% increased odds of 24-hr mortality for every 10 mL/kg platelet deficit [p = 0.02)]).

Conclusions: In injured children, balanced resuscitation may improve early survival according to this hypothesis generating study. Multicenter clinical trials are needed to assess whether clinicians should target ratios and deficits as optimal pediatric hemostatic resuscitation practice.

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Conflict of interest statement

Dr. Spinella received funding from Secure Transfusion Services, Cerus, and New Health Sciences. Dr. Spinella is a consultant for Secure Transfusion Services, Hemanext, and Haima. Drs. Spinella, Leonard, and Josephson received support for article research from the National Institutes of Health. Dr. Leonard’s institution received funding from the National Institutes of Child Health and Human Development; she received royalty payments from UpToDate. Dr. Wisniewski disclosed that he is self-funded. Dr. Josephson received funding from Octapharma LLC. Dr. Josephson is a consultant for Immucor, Octapharma, and Cellphine and has an unrestricted grant from Medtronics. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

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