High ratio plasma resuscitation does not improve survival in pediatric trauma patients

Jeremy W. Cannon, Michael Johnson, Robert C. Caskey, Matthew A. Borgman, Lucas P. Neff

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Damage control resuscitation including balanced resuscitation with high ratios of plasma (PLAS) and platelets (PLT) to packed red blood cells (PRBC) improves survival in adult patients. We sought to evaluate the effect of a high ratio PLAS to PRBC resuscitation strategy in massively transfused pediatric patients with combat injuries. Methods: The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric trauma patients (<18 years). Burns, drowning, isolated head trauma, and older teens were excluded. Those who received massive transfusion (≥40 mL/kg total blood products in 24 hours) and early deaths who received any blood products were then evaluated. Primary outcomes were mortality at 24 hours and in-hospital. Secondary outcomes included blood product utilization over 24 hours, ventilator-free days, intensive care unit-free days, and hospital length of stay. Results: The Department of Defense Trauma Registry yielded 4,980 combat-injured pediatric trauma patients, of whom 364 met inclusion criteria. Analysis of PLAS/PRBC ratios across the entire spectrum of possible ratios in these patients demonstrated no clear inflection point for mortality. Using a division between low (LO) and high (HI) ratios of PLAS/PRBC 1:2, there was no difference in all-cause mortality at 24 hours (LO, 9.2% vs. HI, 8.0%; p = 0.75) and hospital discharge (LO, 21.5% vs. HI, 17.1%; p = 0.39). HI ratio patients received less PRBC but more PLAS and PLT and more total blood products. Those in the HI ratio group also had longer hospital length of stay. Regression analysis demonstrated no associated mortality benefit with a HI ratio (hazards ratio, 2.04; 95% confidence interval, 0.48-8.73; p = 0.34). Conclusion: In combat-injured children undergoing a massive transfusion, a high ratio of PLAS/PRBC was not associated with improved survival. Further prospective studies should be performed to determine the optimal resuscitation strategy in critically injured pediatric patients. Level Of Evidence: Therapeutic study, level III.

Original languageEnglish (US)
Pages (from-to)211-217
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number2
DOIs
StatePublished - Aug 1 2017

Fingerprint

Resuscitation
Pediatrics
Erythrocytes
Survival
Wounds and Injuries
Length of Stay
Mortality
Registries
Blood Platelets
Mechanical Ventilators
Burns
Craniocerebral Trauma
Intensive Care Units
Cell Survival
Regression Analysis
Prospective Studies
Confidence Intervals

Keywords

  • combat injury
  • damage control resuscitation
  • massive transfusion
  • Pediatric trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

High ratio plasma resuscitation does not improve survival in pediatric trauma patients. / Cannon, Jeremy W.; Johnson, Michael; Caskey, Robert C.; Borgman, Matthew A.; Neff, Lucas P.

In: Journal of Trauma and Acute Care Surgery, Vol. 83, No. 2, 01.08.2017, p. 211-217.

Research output: Contribution to journalArticle

Cannon, Jeremy W. ; Johnson, Michael ; Caskey, Robert C. ; Borgman, Matthew A. ; Neff, Lucas P. / High ratio plasma resuscitation does not improve survival in pediatric trauma patients. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 83, No. 2. pp. 211-217.
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N2 - Background: Damage control resuscitation including balanced resuscitation with high ratios of plasma (PLAS) and platelets (PLT) to packed red blood cells (PRBC) improves survival in adult patients. We sought to evaluate the effect of a high ratio PLAS to PRBC resuscitation strategy in massively transfused pediatric patients with combat injuries. Methods: The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric trauma patients (<18 years). Burns, drowning, isolated head trauma, and older teens were excluded. Those who received massive transfusion (≥40 mL/kg total blood products in 24 hours) and early deaths who received any blood products were then evaluated. Primary outcomes were mortality at 24 hours and in-hospital. Secondary outcomes included blood product utilization over 24 hours, ventilator-free days, intensive care unit-free days, and hospital length of stay. Results: The Department of Defense Trauma Registry yielded 4,980 combat-injured pediatric trauma patients, of whom 364 met inclusion criteria. Analysis of PLAS/PRBC ratios across the entire spectrum of possible ratios in these patients demonstrated no clear inflection point for mortality. Using a division between low (LO) and high (HI) ratios of PLAS/PRBC 1:2, there was no difference in all-cause mortality at 24 hours (LO, 9.2% vs. HI, 8.0%; p = 0.75) and hospital discharge (LO, 21.5% vs. HI, 17.1%; p = 0.39). HI ratio patients received less PRBC but more PLAS and PLT and more total blood products. Those in the HI ratio group also had longer hospital length of stay. Regression analysis demonstrated no associated mortality benefit with a HI ratio (hazards ratio, 2.04; 95% confidence interval, 0.48-8.73; p = 0.34). Conclusion: In combat-injured children undergoing a massive transfusion, a high ratio of PLAS/PRBC was not associated with improved survival. Further prospective studies should be performed to determine the optimal resuscitation strategy in critically injured pediatric patients. Level Of Evidence: Therapeutic study, level III.

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