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. 2025 Sep-Oct;32(5):298-303.
doi: 10.1097/JTN.0000000000000874. Epub 2025 Sep 5.

Pediatric Massive Transfusion Protocol Dose Book: A Guide to Improve Balanced Ratios

Tiffany L Taylor  1 , Joshua Dugal, Steven P Laffey, Sandra P Spencer, Kelly B Thompson
Affiliations

Pediatric Massive Transfusion Protocol Dose Book: A Guide to Improve Balanced Ratios

Tiffany L Taylor et al. J Trauma Nurs. 2025 Sep-Oct.

Abstract

Background: Pediatric massive transfusion protocol activation is rare, even in high-volume trauma centers. Maintaining competency in these low-frequency, high-risk events is challenging and often impedes balanced resuscitation.

Objective: This project aims to evaluate the effectiveness of a pediatric massive transfusion protocol dose book in improving packed red blood cell to plasma ratios during massive transfusion events.

Methods: This pre-post quality improvement study was conducted over 5 years (June 2019-March 2024) at an urban Midwestern U.S. pediatric Level I trauma center. Inclusion criteria were trauma patients under 18 years who received ≥40 mL/kg of blood products within the first 24 hours. The intervention was a novel weight-based dose book designed to guide balanced resuscitation. The primary outcome was adherence to a 1:1 packed red blood cell to plasma ratio.

Results: Among 29 massive transfusion activations, the average packed red blood cell-to-plasma ratio improved from 3.38:1 (preimplementation) (n = 14) to 1.37:1 (postimplementation) (n = 15).

Conclusion: Implementing a pediatric massive transfusion protocol dose book improved adherence to balanced blood product administration during massive transfusion events.

Keywords: Balanced resuscitation; Blood ratios; Massive transfusion protocol; Pediatric trauma; Quality improvement.

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Conflict of interest statement

No authors have any disclosures or financial conflicts of interest related to this content.

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