Transfusion in transit: A decade of prehospital blood transfusion in pediatric trauma.

BACKGROUND

Prehospital blood transfusion improves mortality in adults, with limited evidence in children. This study describes prehospital blood transfusion in pediatric trauma patients and the impact on shock index, pediatric adjusted (SIPA).

METHODS

This study is a retrospective cohort study of trauma patients younger than 18 years who received blood transfusions during helicopter transport to a Level 1 pediatric trauma center from 2011 to 2023. Primary outcome was change in SIPA at time of emergency department (ED) arrival with prehospital transfusion. Secondary subgroup analysis was performed based on transport origin.

RESULTS

Of 137 patients, 58% (80 of 137 patients) were male (median age, 9.3 years [interquartile range (IQR), 4.3-14.5 years]) with a median Injury Severity Score of 26 (IQR, 17-38); 57% (77 of 137 patients) were transported from the scene, and 43% (60 of 137 patients) from another hospital. The median blood volume administered was 300 mL (IQR, 200-535 mL) or 10 mL/kg (IQR, 7-16 mL/kg). Patients were more physiologically imbalanced prior to transfusion (median heart rate, 124 beats per minute [bpm; IQR, 102-150 bpm]; systolic blood pressure, 80 mm Hg [IQR, 63-99 mm Hg]) than at ED arrival (median heart rate, 112 bpm [IQR, 97-133 bpm]; systolic blood pressure, 102 mm Hg [IQR, 84-120 mm Hg]). Shock index, pediatric adjusted, was decreased at ED arrival (median SIPA preblood, 1.52 [IQR, 1.11-2.16]; median SIPA ED arrival, 1.10 [IQR, 0.89-1.38]). The SIPA transitioned from abnormal to normal at ED arrival in 24% (32 of 131 patients); hemodynamic improvement was more pronounced in patients from the scene. Death in the first 24 hours occurred in 43 patients; 25 presented in cardiac arrest and died on ED arrival. Most deaths (81%, 47 of 58 patients) were associated with traumatic brain injury.

CONCLUSION

After receiving prehospital transfusion, 35% of children arrived with a normal shock index, and 24% converted from abnormal to normal SIPA by ED arrival, with significant hemodynamic improvement in patients transported from both the scene and other hospitals. These results support prehospital transfusion as critical for the treatment of hemorrhagic shock in children.

LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.