A high plasma to PRBC transfusion ratio (>/= 1:2) was not beneficial in pediatric massive trauma transfusion. But this study was different than adult studies of damage control resuscitation in that these children did not receive platelets.
Why does this matter?
High ratio transfusion of plasma, platelets, and PRBCs was shown to be beneficial in adults needing massive transfusion. Then PROPPR showed a decrease in mortality due to exsanguination. But does the same hold true for children?
Pediatric patients and massive transfusion
This was a retrospective review of the Department of Defense registry. It identified 392 children under age 18 with trauma who required > 40mL/kg total transfusion. They found no mortality benefit at 24 hours or in-hospital and also found the higher plasma to PRBC ratio transfusion patients stayed in the hospital longer. Until we have a prospective study to guide us, the benefit of high plasma to PRBC ratios in children who need massive transfusion is unclear. Also, one wonders whether the addition of platelets, as in the PROPPR study, would have made a difference. Given this state of equipoise, it is reasonable to add plasma and platelets to children requiring massive transfusion.
High ratio plasma resuscitation does not improve survival in pediatric trauma patients. J Trauma Acute Care Surg. 2017 Aug;83(2):211-217. doi: 10.1097/TA.0000000000001549.
Peer reviewed with significant contribution by Thomas Davis.