Pediatric massive transfusion protocols
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1 University of New Mexico UNM Digital Repository Emergency Medicine Research and Scholarship Emergency Medicine 2014 Pediatric massive transfusion protocols Ramsey Tate Follow this and additional works at: Recommended Citation Tate, Ramsey. "Pediatric massive transfusion protocols." (2014). This Presentation is brought to you for free and open access by the Emergency Medicine at UNM Digital Repository. It has been accepted for inclusion in Emergency Medicine Research and Scholarship by an authorized administrator of UNM Digital Repository. For more information, please contact
2 Transfusing tiny soldiers Ramsey C. Tate, MD Fellow, Pediatric Emergency Medicine
3 Applying combat-derived massive transfusion protocols to pediatric trauma patients
4 Agenda Case Damage control resuscitation Massive transfusion protocols Pediatric massive transfusion protocols
5 Agenda Case Damage control resuscitation (DCR) Massive transfusion protocols (MTP) Pediatric massive transfusion protocols (P-MTP)
6
7 Damage Control Resuscitation
8 Damage Control Resuscitation Permissive hypotension Aggressive correction of coagulopathy Use of blood products and vasopressors to maintain hemodynamics and euvolemia
9 Damage Control Resuscitation Permissive hypotension Aggressive correction of coagulopathy Use of blood products and vasopressors to maintain hemodynamics and euvolemia Hemostatic resuscitation
10 Damage Control Resuscitation Acidosis Hypothermia Death Coagulopathy
11 Massive transfusion protocols
12 Fresh whole blood: 500 ml Hct 33-43% Plt ,000 Fibrinogen 1500 mg Clotting activity 86% Full platelet activity Warm
13 Fresh whole blood: 500 ml Hct 33-43% Plt ,000 Fibrinogen 1500 mg Clotting activity 86% Full platelet activity Warm RBC + Platelets + FFP: 660 ml Hct 29% Plt 88,000 Fibrinogen 750 mg Clotting activity 65% Reduced platelet activity Cold
14 Fresh whole blood: 500 ml Hct 33-43% Plt ,000 Fibrinogen 1500 mg Clotting activity 86% Full platelet activity Warm RBC + Platelets + FFP: 660 ml Hct 29% Plt 88,000 Fibrinogen 750 mg Clotting activity 65% Reduced platelet activity Cold 1:1:1
15 Key components of MTP Resuscitation with predetermined ratios of blood components Rapid infusion of warmed blood products Coordination with transfusion specialists to ensure streamlined delivery of products Monitoring of coagulation studies to determine the end-point of protocol
16 Key components of MTP Resuscitation with predetermined ratios of blood components 1 RBC:1 FFP:1 Platelet Rapid infusion of warmed blood products Coordination with transfusion specialists to ensure streamlined delivery of products Monitoring of coagulation studies to determine the end-point of protocol
17 Key components of MTP Resuscitation with predetermined ratios of blood components Rapid infusion of warmed blood products Coordination with transfusion specialists to ensure streamlined delivery of products Monitoring of coagulation studies to determine the end-point of protocol
18 Key components of MTP Resuscitation with predetermined ratios of blood components Rapid infusion of warmed blood products Coordination with transfusion specialists to ensure streamlined delivery of products Monitoring of coagulation studies to determine the end-point of protocol
19 Key components of MTP Resuscitation with predetermined ratios of blood components Rapid infusion of warmed blood products Coordination with transfusion specialists to ensure streamlined delivery of products Monitoring of coagulation studies to determine the end-point of protocol
20
21 Math is hard Pediatric considerations
22 5 liters 0.5 liters
23 5 liters Transfusion of one blood volume in 24 hours Transfusion of one-half blood volume in 3 hours 0.5 liters
24 adapted by Brian Johnston and Ramsey Tate Harborview pediatric MTP
25 Still in development UNM pediatric MTP UNM may be a research site for P-MTP study Weight (kg) Total Blood Volume Blood Pack "Shipment" Crystalloid 20 ml/kg Crystalloid 40 ml/kg RBC 30 ml/kg Plasma 30 ml/kg Platelets 5 ml/kg Cryo 2 ml/kg 10% Calcium Gluconate A B A B A B A B A
26 Pediatric considerations Math is hard prbcs FFP Platelets Cryoprecipitate TXA ml/kg ml/kg 5-20 ml/kg 2-5 ml/kg 20 ml/kg
27 Pediatric considerations Math is hard Critical importance of warming (ENFLOW)
28 Pediatric considerations Math is hard Critical importance of warming (ENFLOW) Different blood product preparation
29 Pediatric considerations Math is hard Critical importance of warming (ENFLOW) Different blood product preparation Difficult to interpret functional coagulation studies (ROTEM)
30 Pediatric considerations Math is hard Critical importance of warming (ENFLOW) Different blood product preparation Difficult to interpret functional coagulation studies (ROTEM) Anticipate electrolyte abnormalities
31 Pediatric considerations Math is hard Critical importance of warming (ENFLOW) Different blood product preparation Difficult to interpret functional coagulation studies (ROTEM) Anticipate electrolyte abnormalities Scant research
32 Questions?
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