4 - WHOLE BLOOD RESUSCITATION IS SAFE IN PEDIATRIC TRAUMA PATIENTS: A MULTICENTER STUDY

Objectives: Whole blood (WB) resuscitation has been associated with a mortality benefit in trauma patients. Several small series report the use of WB in the pediatric population which demonstrate that WB is safe to use during trauma resuscitation. We performed a subgroup analysis of the pediatric patients from a large multicenter trial comparing patients who received WB or blood component therapy (BCT) during trauma resuscitation. We hypothesized that WB resuscitation would be safe when compared to BCT resuscitation in pediatric trauma patients.

Methods: This prospective observational study included pediatric trauma patients (0-17 years) from ten verified Level-I trauma centers in the US. All pediatric patients who received any blood transfusion during the initial resuscitation were included. Patients were included in the WB group if they received at least one unit of WB during their resuscitation, and patients in the BCT group are patients who received traditional blood product resuscitation. The primary outcome was in hospital mortality with secondary outcomes being pulmonary complications, venous thromboembolism and acute kidney injury. Statistical analysis was performed utilizing Chi square and Fisher’s exact tests for categorical variables and independent samples t-tests for continuous variables. Multivariate logistic regression was performed to assess for mortality and complications in those treated with WB versus BCT.

Results: Ninety pediatric patients were enrolled in the study [WB: 62 (69%), BCT: 28 (21%)]. There was a mix of patients with both penetrating and blunt mechanisms of injury (MOI). Patients in the WB were more likely to be male. There were no differences in age, MOI, shock index, or injury severity score between groups. (Table 1) When controlling for age, MOI and shock index, there were no differences in complications between groups. There were no reported transfusion reactions or hemolytic complications in any patient. Mortality was not different between the groups [WB: 22 (35.5%), BCT: 10 (35.7%), p=0.983].

Conclusion: To our knowledge this is the largest prospective observational study of the outcomes of pediatric trauma patients receiving WB resuscitation. Our data suggests that WB resuscitation is safe when compared to BCT resuscitation in the care of critically injured pediatric trauma patients.