Time is tissue: Barriers to timely transfusion after pediatric injury

Abstract

Strategies to improve outcomes among children and adolescents in hemorrhagic shock have primarily focused on component resuscitation, pharmaceutical coagulation adjuncts, and hemorrhage control techniques. Many of these strategies have been associated with better outcomes in children, but the barriers to their use and the impact of timely use on morbidity and mortality have received little attention. Because transfusion is uncommon in injured children, few studies have identified and described barriers to the processes of using these interventions in bleeding patients, processes that move from the decision to transfuse, to obtaining the necessary blood products and adjuncts, and to delivering them to the patient. In this review, we identify and describe the steps needed to ensure timely blood transfusion and propose practices to minimize barriers in this process. Given the potential impact of time on hemorrhage associated outcomes, ensuring timely intervention may have a similar or greater impact than the interventions themselves.

Figure 1.

Barriers to Timely Transfusion

Figure 2.

Impact of a 10 Minute Delay from Arrival to the First Unit of Blood with and without a Massive Transfusion Requirement on 30-day Mortality. Data based on Meyer, et al. (5) and Powell, et al. (14). Massive transfusion defined as 37cc/kg/4hr (27).

Figure 3.

Percentage of Injured Children Requiring Blood Transfusion and Massive Blood Transfusion. Data provided from National Trauma Data Bank (26).

Figure 4.

Time is Tissue