Dressler am, finck cm, carroll cl, bonanni cc, spinella pc. The definition of what constitutes a massive transfusion in a child, most commonly used definition being 40 mlkg of blood products within any 24 h period, was pushed to a lower volume suggesting the need for more ready use of a massive transfusion protocol when these patients are encountered. The latest version of this document is available on the cdhb intranetwebsite only. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage. Pediatric massive transfusion protocol pmtp emergency release of blood from blood bank. Massive transfusion in pediatric trauma journal of pediatric surgery.
Fluid resuscitation and massive transfusion protocol in. Children massively transfused after mtp received mean plasma. Pediatric massive transfusion protocol emergency medicine. Despite this, many adult massive transfusion protocols suggest a prbc. One bedside individual assigned by the physician lead activating the mtp to communicate with the transfusion. We present a pediatric mtp and examine its impact on morbidity and mortality as well as identify factors that may prompt protocol initiation. Pediatric massive transfusion protocol polices 46 childrens hospitals physician discretion was the most common activation criteria 89% most sites targeted equal ratios of plasma.
Implementation of a pediatric trauma massive transfusion protocol. Studies demonstrate improved patient outcome with implementation of a massive transfusion protocol mtp when compared to physicianlab driven resuscitation 4,5,8,9. The effect of massive transfusion protocol implementation on pediatric trauma care. Mtp, of whom 26 and 17 received massive transfusion in the pre. Department of pathology, transfusion medicine attending physician office. Prbc usage approached 80mlkg24 h or 40mlkg12 h hendrickson et al. Informed consent for transfusion is necessary and must be documented. The trauma team and blood bank should strive to ensure a seamless massive transfusion occurs with a goal of providing a 1. Pediatric massive transfusion protocol mtp procedure and information pediatric massive transfusion protocol suggested indications to activate mtp. Pediatric massive transfusion protocol february 2016. This is the second medical handout completed the task this time was to come up with a clearer simplification of the pediatric massive transfusion protocol used by medical staff to assess the need for various durg and blood volumes for their pediatric patients during surgery the handout is inspired off of a slide from issues in the management of pediatric. If ffp is not immediately available based on type of patient, the blood bank will issue units that are ready and. Pediatric massive transfusion protocol saskatoon health region. Unfortunately, there are no similar pediatric studies.
Incidence, patient profile, and outcomes prior to a massive transfusion protocol. An editable electronic template mtp is available on the nbas website. Senior clinician identifies critical bleeding event. Massive transfusion in paediatric and adolescent trauma patients. Two trials were small approximately 100 patients nonrandomized trials into pediatric hemorrhage managed as per a massive transfusion protocol or at physician discretion. Paediatric massive transfusion bja education oxford academic. Chapter 4 discusses local adaptation of the template mtp 4. Massive transfusion remains an area of great study throughout the critical care and trauma literature, and many hospitals now have developed their own massive transfusion protocols mtp. Adults have about 5 l of circulating blood not including plasma, one could replace all circulating erythrocytes with about 10 units of prbcs. Guidelines for massive transfusion, in the pediatric trauma, have not been defined yet. The massive transfusion protocol mtp is a cooperative effort between the clinical service and the blood bank to ensure prompt response in emergent situations.
Paediatric massive transfusion protocol western health. The effect of massive transfusion protocol implementation on. The revised assessment of bleeding and transfusion rabt score. Although massive transfusion protocols would improve the outcomes and reduce the received blood products during transfusion, pediatric patients differ from adults in the tolerability to. Massive transfusion dr andrew blanch in paediatric trauma. Time to delivery of initial massive transfusion cooler and its impact on mortality.
Background pediatric massive blood transfusions occur widely at hospitals across the nation. Pediatric transfusion guidelines approved by medical staff executive committee on 12112006 i. Apr 22, 2019 massive transfusion protocol mtp is an important step in most trauma protocols. Massive transfusion, historically defined as the replacement by transfusion of 10 units of red cells in 24 hours, is a response to massive and uncontrolled hemorrhage. Massive transfusion and massive transfusion protocols. Massive transfusion protocols howevertrauma cases requiring a damage control resuscitation massive transfusion are. Use of a massive transfusion protocol with hemostatic resuscitation for severe intraoperative bleeding in a child. Pdf massive transfusion protocols for pediatric patients. Pediatric massive transfusion allegheny anesthetists.
Not including plasma, one could replace all circulating erythrocytes with about 10 units of prbcs. Evidence of acidosis base deficit 6, coagulopathy inr1. Stable, growing, hgb pediatric massive transfusion protocol. Therefore clinical physicians have requested for a pediatric massive transfusion protocol. We hope that the compendium becomes an essential educational resource and reference guide for transfusion. Common causes of massive haemorrhage in paediatric patients include accidental and non. Page 11 of 12 pediatric massive transfusion protocol flowchart effective date.
Pediatric massive blood transfusions occur widely at hospitals across the nation. Stable, growing, hgb massive transfusion protocol mtp paediatric date of publishing. Reviewed and revised 10 march 2014 overview massive transfusion is defined as replacement of 1 blood volume in 24 hours, or 50% of blood volume in 4 hours adult blood volume is approximately 70 mlkg, or in children. With more rapid and effective therapy, alternative definitions such as three units of red blood cells over one hour or any four blood components in 30 minutes are more sensitive. Pediatric massive transfusion protocol procedure and information location or contact person 272 revised owner. Only 15% of the respondents based their decision to initiate a massive transfusion protocol using a. Massive transfusion in children and neonates diab 20 british. All authors cited conclude that mtp in the pediatric population is an area in need of further study. Paediatric massive transfusion protocol paed mtp document no. Feb 15, 2015 massive transfusion protocols in paediatric trauma patients. By recognizing the severity of injury and intervening quickly by giving blood products upfront, mtp has been shown to decrease icu length of stay, decrease ventilator length of use, decrease mortality rates, and has been shown to decrease the number of blood products needed over the entire length of stay. This policyprocedure may be varied, withdrawn or rep laced at any time. Requiring 40 mlkg 40% blood volume or 4 u for adult patient 30 kg over 2 hours or less. A recent survey in the us and canada indicated that, in children, massive transfusion protocol activation criteria are most often based on physician discretion, a nonspecific trigger.
Massive transfusion protocol rush emergency medicine. Pediatric trauma society massive transfusion protocol. Paediatric massive transfusion bja education oxford. Quick instigation of a balanced transfusion strategy with rbc, ffp and plt in a 1. A comparison of these publications makes it clear that a firm consensus is lacking regarding definitive indications for transfusion of pediatric patients. Massive blood loss in the paediatric patient, often from blunt trauma, can be difficult to assess. Here we tried to identify certain principles of fluid and transfusion therapies that are specific for pediatric trauma,and to present a sample of massive transfusion protocol mtp that can be used to guide resuscitation.
This policy will apply to both pediatric and adult patient populations and is based on estimated weight using broselow pediatric emergency tape of the patient. Massive transfusion in the pediatric population was defined as the transfusion of blood components equaling one or more blood volumes within a 24hour time frame or half of a blood volume in 12 hours. Spinella4 a survey of us and canadian hospitals paediatric massive transfusion protocol policies transfusion medicine, 2016, 26, 49 56. Pediatric massive transfusion protocol flowchart effective date. Pediatric massive transfusion protocol pmtp emergency. Current data indicate that early identification of coagulopathy and its treatment with rbss, plasma and platelets in a 1. Massive blood transfusion protocol mbtp cincinnati childrens hospital medical center objective to outline a standard process for safe, rapid preparation and delivery of blood products and coagulation factors for the pediatric patient requiring massive blood transfusion. It is vital that the trauma program work with blood banking personnel to develop the massive transfusion protocol, determine ratios, and quantities available.