Pediatric Massive Transfusion Protocol Dose Book: A Guide to Improve Balanced Ratios.

BACKGROUND

Pediatric massive transfusion protocol activation is rare, even in high-volume trauma centers. Maintaining competency in these low-frequency, high-risk events is challenging and often impedes balanced resuscitation.

OBJECTIVE

This project aims to evaluate the effectiveness of a pediatric massive transfusion protocol dose book in improving packed red blood cell to plasma ratios during massive transfusion events.

METHODS

This pre-post quality improvement study was conducted over 5 years (June 2019-March 2024) at an urban Midwestern U.S. pediatric Level I trauma center. Inclusion criteria were trauma patients under 18 years who received ≥40 mL/kg of blood products within the first 24 hours. The intervention was a novel weight-based dose book designed to guide balanced resuscitation. The primary outcome was adherence to a 1:1 packed red blood cell to plasma ratio.

RESULTS

Among 29 massive transfusion activations, the average packed red blood cell-to-plasma ratio improved from 3.38:1 (preimplementation) (n = 14) to 1.37:1 (postimplementation) (n = 15).

CONCLUSION

Implementing a pediatric massive transfusion protocol dose book improved adherence to balanced blood product administration during massive transfusion events.