Additionally, the predominance of blast and other penetrating mechanisms did not generally reflect the average pediatric trauma patient who is injured from more common mechanisms. 16 Given this 24-h time frame, the introduction of survival bias may have confounded the assessment in that some children did not survive past the first 24 h or survive long enough to meet the 40mL/kg/24hr threshold. A recent study of children treated in a combat environment indicated that roughly half of the total blood volume transfused within a 24-h period reliably identified critically injured children at risk for death. 6, 13 – 15 These rather crude definitions are borne out of the difficulty in accessing large amounts of pooled patient data with the appropriate level of detail. 8 – 12Īs such, many pediatric MT definitions are based on the volume of blood products transfused as a function of the estimated total blood volume for the child over a 4 h, 12 h or 24-h period. This attempt to create a standardized definition as the foundation of further inquiry has been limited by the heterogeneity of patient populations studied and the difficulty in acquiring the granularity of detail required to adequately describe each MTP activation. This difficulty in a universal definition is apparent in the adult transfusion literature as well, with multiple competing definitions of MT, all seeking to adequately describe this patient population. Over the last several years, multiple pediatric studies have attempted to define MT in the pediatric population as the initial step towards developing prediction tools and refining protocols using retrospective data sets. We aim to not only summarize current evidence-based practices in pediatric massive transfusion but also to highlight future directions in this field and present ideas for future study to improve the care and outcomes of pediatric patients.ĭefinition of Massive Transfusion in Children 7 This review of massive transfusion protocols in pediatric patients consisted of a search of the PubMed and Google Scholar databases. This subset of trauma victims is generally older, more hypothermic, with a higher injury severity score when compared with other pediatric trauma patients who may have been transfused but did not meet the criteria for pediatric massive transfusion (MT). 3 – 6 Despite these varied reasons for hemorrhage, traumatic injury remains the main driver for activation of a pediatric MTP. Additional etiologies of life-threatening hemorrhage include operative complications, invasive tumors whose removal results in significant blood loss, liver surgery and gastrointestinal bleeding. 1, 2 Bleeding from these mechanisms can be severe enough to warrant massive transfusion protocol (MTP) activations. Injury is the leading cause of death in children and adolescents with falls and motor vehicle accidents as the two leading mechanisms of injury.
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