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Balanced Damage Control Resuscitation Is Associated With Improved Outcomes In Severely Injured Pediatric Trauma Patients.
Muhammad Zeeshan, Faisal Jehan, Muhammad Khan, Marc Arkovitz, Peter Rhee, *Dylan Stewart
Westchester Medical Center, Valhalla, NY

Background (issue):
Massive transfusion(MT) in a ratio of 1:1:1(PRBC:Platelet:FFP) is the standard of care in hemorrhaging trauma patients. The aim of our study was to compare the outcomes of pediatric trauma patients who received near balanced resuscitation(NBR) vs unbalanced resuscitation(UBR) during the initial phase of resuscitation.
Methods:
We performed a three-year(2014-2016) analysis of the Pediatric ACS-TQIP database. Pediatric trauma patients(age≤17) who received MT(transfusion of PRBC ≥20 mL/kg in 24-hours) were included. Patients were stratified based on ratios of blood products: NBR defined as PRBC:Platelets:FFP in 1:>0.5:>0.5 and UBR as 1:<0.5:<0.5 during the first 4 hours of resuscitation. Primary outcome measure was mortality. Secondary outcome measures were acute kidney injury(AKI) and acute respiratory distress syndrome(ARDS). Regression analysis was performed.
Findings:
536 patients received MT. Mean age was 10+6 years, median ISS was 30 [26-38]. 26.1% of patients received NBR while 73.9% received UBR in the first 4 hours. Patients who received NBR had lower 24-hour mortality(14.3% vs 25.6%,p=0.02), lower in-hospital mortality(40% vs 44.7%,p=0.02), and lower rates of AKI(1.4% vs 3.8%,p=0.03) compared to UBR recipients. ARDS rates were the same (3.5% vs 4.0%,p=0.22). On regression analysis controlling for demographics, ED vitals, ISS, and AIS, NBR was independently associated with lower odds of 24-hour mortality(OR:0.69[0.52-0.90]); lower odds of in-hospital mortality(OR:0.78[0.58-0.97]); and lower odds of AKI(OR: 0.89 [0.85-0.98].
Conclusions (implications for practice):
Only one-fourth of the pediatric trauma patients receiving massive transfusion received near balanced resuscitation in the initial 4-hours. Patients who received near balanced resuscitation had lower mortality and AKI compared to patients who had unbalanced resuscitation.


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