To give or not to give? Blood for pediatric trauma patients prior to pediatric trauma center arrival
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In brief
In brief
This retrospective study demonstrates that prehospital blood product administration to severely injured pediatric trauma patients during transport is safe and improves shock markers upon arrival at the trauma center. Patients receiving blood prior to arrival showed improved lactate and hemoglobin levels and required less crystalloid resuscitation without increased mortality compared to matched controls.
Written by the GCMD Library team from the article.
Abstract
Purpose
This study evaluates the indications, safety and clinical outcomes associated with the administration of blood products prior to arrival at a pediatric trauma center (prePTC).
Methods
Children (≤ 18 years) who were highest level activations at an ACS level 1 pediatric trauma center (PTC) from 2009–2019 were divided into groups:(1) patients with transport times < 4 h who received blood prePTC(preBlood) versus (2) age matched controls with transport times < 4 h who only received crystalloid prePTC (preCrystalloid).
Results
Of 1269 trauma activations, 38 met preBlood and 38 met preCrystalloid inclusion criteria. A similar volume of prePTC crystalloid infusion was observed between cohorts (p = 0.311). PreBlood patients evidenced greater hemodynamic instability as demonstrated by higher prePTC pediatric age-adjusted shock index (SIPA) scores. PreBlood patients showed improvement in lactate (p = 0.038) and hemoglobin (p = 0.041) levels upon PTC arrival. PreBlood patients received less crystalloid within 12 h of PTC admission (p = 0.017). No significant differences were found in blood transfusion volumes within six (p = 0.293) and twenty-four (p = 0.575) hours of admission, nor in mortality between cohorts (p = 0.091).
Conclusions
The administration of blood to pediatric trauma patients prior to arrival at a PTC is safe, transiently improves markers of shock, and was not associated with worse outcomes.