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Examining 1:1 Versus 4:1 Packed Red Blood Cell to Fresh Frozen Plasma Ratio Transfusion During Pediatric Burn Excision
Tejiram S, Sen S, Romanowski KS, Greenhalgh DG, Palmieri TL
Journal of burn care & research : official publication of the American Burn Association. 2020
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Abstract
Blood transfusions following major burn injury are common due to operative losses, blood sampling, and burn physiology. While massive transfusion improves outcomes in adult trauma patients, literature examining its effect in critically ill children is limited. The study purpose was to prospectively compare outcomes of major pediatric burns receiving a 1:1 vs 4:1 packed red blood cell (PRBC) to fresh frozen plasma (FFP) transfusion strategy during massive burn excision. Children with >20% total body surface area (TBSA) burns were randomized to a 1:1 or 4:1 PRBC/FFP transfusion ratio during burn excision. Parameters examined include patient demographics, burn size, Pediatric Risk of Mortality (PRISM) scores, Pediatric Logistic Organ Dysfunction (PELOD) scores, laboratory values, total blood products transfused, and the presence of blood stream infections or pneumonia. A total of 68 children who met inclusion criteria were randomized into two groups (n=34). Mean age, PRISM scores, estimated blood loss (600 mL (400 - 1175 mL) v 600 mL (300 - 1150 mL), p = 0.68), ventilator days (5 v 9, p = 0.47), and length of stay (57 v 60 days, p = 0.24) had no difference. No differences in frequency of blood stream infection (20 v 18, p = 0.46) or pneumonia events (68 v 116, p = 0.08) were noted. On multivariate analysis, only TBSA burn size, inhalation injury, and PRISM scores (p < 0.05) were significantly associated with infections.
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Randomized comparison of packed red blood cell-to-fresh frozen plasma transfusion ratio of 4: 1 vs 1: 1 during acute massive burn excision
Galganski LA, Greenhalgh DG, Sen S, Palmieri TL
Journal of Burn Care & Research.. 2016;38((3):):194-201
Abstract
This prospective randomized controlled trial compared 1:1 vs 4:1 packed red blood cell with fresh frozen plasma (PRBC/FFP) transfusion strategy on outcomes in children with >20% TBSA burns. Children with >20% TBSA burns were randomized to a 1:1 or 4:1 PRBC/FFP transfusion ratio during burn excision. Parameters measured included demographics, TBSA burn, and Pediatric Risk of Mortality scores. Laboratory values recorded preoperatively, 1 hour, 12 hours, 24 hours, and 1 week postoperatively included prothrombin time, partial thromboplastin time (PTT), international normalized ratio, fibrinogen, protein C, and antithrombin C (AIII). Total number of blood products transfused intraoperatively and during hospitalization was recorded. Forty-five children were enrolled, 22 in the 1:1 and 23 in the 4:1 group. Groups were similar in age, TBSA, and Pediatric Risk of Mortality score. Preoperative fibrinogen, AIII, protein C, hemoglobin, PTT, international normalized ratio, and platelets were similar. In the first two excisions, the 1:1 group received significantly more FFP per patient. Volume of PRBC and overall product transfused did not differ between groups. At 1 hour postoperatively, prothrombin time and PTT were lower and protein C and AIII were higher in the 1:1 group. The 4:1 group was more significantly acidotic 1 hour postexcision. A 1:1 PRBC/FFP transfusion strategy, compared with a 4:1 strategy, decreased postoperative markers of coagulopathy and acidosis immediately after surgery. The strategy did not change the total volume of blood product transfused. This interim analysis was not powered to detect differences in wound healing and length of stay. ES 1559-0488 IL 1559-047X