Whole Blood Hemostatic Resuscitation in Pediatric Trauma: A Nationwide Propensity-Matched Analysis
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Aug 2021 · 1 min read
In brief
In brief
This propensity-matched analysis of 405 pediatric trauma patients demonstrates that whole blood as an adjunct to component therapy significantly reduces total transfusion requirements at 4 and 24 hours and decreases ventilator days, without differences in mortality or major complications compared to component therapy alone.
Written by the GCMD Library team from the article.
Background: Whole blood (WB) has shown promise in pediatric trauma resuscitation following its prominent role in the resuscitation of adult trauma patients. Although WB in children has been shown to be feasible, its effectiveness has yet to be explored. The aim of this study is to examine the outcomes of WB transfusion as an adjunct to component therapy (CT) compared to CT only as early resuscitation for pediatric trauma patients.
Methods: Children aged 1-17 years, who were transfused within 4 hours of presentation, were identified in the TQIP 2017 database. Patients were stratified into those receiving WB + CT vs. CT alone. Propensity-score matching in a 1:2 ratio was performed based on patient demographics, injury characteristics, hemorrhage control interventions, and trauma center level. The primary outcome measure was patient transfusion requirement. Secondary outcome measures were mortality, hospital length of stay (LOS), ventilation days, and major complications.
Results: A total of 135 children receiving WB + CT were matched to 270 patients receiving CT only. Mean age was 12 ± 5 years, 66% were male, and median ISS was 32 [20-43]. A total of 51% of patients were in shock, 34% had penetrating injuries, and 41% required surgical intervention for hemorrhage control. Total blood products transfused were significantly decreased in children receiving WB, both at 4 hours (35 [22-73] vs. 48 [33-95] mL/kg; p = 0.013) and 24 hours (39 [24-97] vs. 53 [36-119] mL/kg; p < 0.001). Mortality rate at 24 hours (19.3 vs. 21.9%; p = 0.546) and in-hospital mortality (31.1 vs. 34.4%; p = 0.502) were not different. Similarly, no difference in hospital LOS and rates of major complications were found. Patients in the WB group required significantly less ventilation days (2 [2-6] vs. 3 [2-8] days; p = 0.021).
Conclusion: Utilizing WB as an adjunct to CT was associated with decreased transfusion requirements and ventilation days in pediatric trauma patients.
DOI: 10.1097/TA.0000000000003306