Massive transfusion in pediatric trauma: An ATOMAC perspective.

Abstract Background/Purpose Massive transfusion protocols (MTPs) are considered valuable in pediatric trauma. Important questions regarding the survival benefit and optimal blood component ratio remain unknown. Methods The study time frame was January 2007 through December 2013 five Level I Pediatric Trauma Centers reviewed all trauma activations involving children ≤ 18 years of age. Included were patients who either had the institutional MTP or received u003e 20 mL/kg or u003e 2 units packed red blood cells (PRBCs). Results 110/202 qualified for inclusion. Median age was 5.9 years (3.0–11.4). 73% survived to discharge; median hospitalization was 10 (3.1–22.8) days. Survival did not vary by arrival hemoglobin (Hgb), gender or age. Partial prothrombin time (PTT), INR, GCS and injury severity score (ISS) significantly differed for nonsurvivors (all p  Conclusion In pediatric trauma pRBC:FFP ratio of 1:1 was associated with the highest survival of severely injured children receiving massive transfusion. Ratios 2:1 or ≥ 3:1 were associated with significantly increased risk of death. These data support a higher proportion of plasma products for pediatric trauma patients requiring massive transfusion. Level of evidence Level IV.