<< Pediatric Blunt Abdominal Trauma In The Emergency Department: Evidence-Based Management Techniques (Trauma CME)

Controversies And Cutting Edge

Massive transfusion generally refers to > 10 units of PRBCs within the first 24 hours of admission.14 Protocols have been developed to rapidly control bleeding and reduce the detrimental effects of coagulopathy, hypothermia, and acidosis.14 Improved survival has been found in adults with early administration of PRBCs, plasma, and platelets, while minimizing aggressive crystalloid administration, but pediatric data are inconclusive.14 There has been an overall trend towards a 1:1 ratio of fresh-frozen plasma (FFP):PRBC in massive transfusion protocols. A meta-analysis of 16 retrospective studies confirmed a significantly lower mortality rate in patients treated with the highest FFP and/or platelet ratio when compared with the lowest FFP and/or platelet ratio.134 However, few studies have examined the impact of balanced resuscitation in pediatric trauma patients requiring massive transfusion. A retrospective review of 105 massively transfused pediatric trauma patients found that higher plasma/PRBC and platelet/PRBC ratios were not significantly associated with increased survival rates.135 Further prospective studies are needed to establish the optimum ratios of blood products for massive transfusion in children.

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