O2164: Transfusion in Transit: Investigating Prehospital Blood Utilization in Pediatric Trauma

Background: Hemorrhage is the leading reversible cause of death in children after trauma. Prehospital blood resuscitation has been shown to improve mortality in adults, but limited studies exist in children. We aim to describe a decade of experience with prehospital blood transfusion in pediatric trauma patients at a high-volume trauma center.

Methods: This is a retrospective study of pediatric patients (age < 18 years) who received prehospital blood resuscitation during helicopter transport to a single large metropolitan level 1 pediatric trauma center between 2011 and 2023. Indications for blood transfusion are obvious trauma with a systolic blood pressure (SBP) < 70 + (age x 2), and blood is dosed at 20mL/kg. Mechanism, injury severity score (ISS), blood volume in the first 24 hours, heart rate (HR), systolic blood pressure (SBP), laboratory data, and mortality were collected. The Pediatric Age-Adjusted Shock Index (SIPA) was calculated before and after transport. Statistical analysis was performed with descriptive measures and Wilcoxon signed-rank test.

Results: Of the 139 patients, 58% were male, and the median age was 9.6 (IQR 4.4-14.5) years. The median ISS was 27 (IQR 17-41). 68% had a blunt mechanism, 72% had injury to the neck, chest, abdomen, or pelvis, and 40% required an immediate intervention for hemorrhage control upon arrival. 56% of patients were transported from another hospital and 44% directly from the scene. 49% of patients received packed red blood cells, 53% plasma, and 30% whole blood. On average, patients were more physiologically deranged at the beginning of transport (median HR 114 [IQR 71-144] bpm; SBP 73 [IQR 44-115] mmHg) than on arrival to the hospital (median HR 107 [IQR 79-130] bpm; SBP 98 [IQR 64-118] mmHg). Likewise, SIPA scores were closer to normal range after blood product resuscitation during transport (median SIPA pre-transport was 1.26 [IQR 0.89-2.0] compared to 1.04 [IQR 0.85-1.3] post-transport). Comparing those who had pre-transport and post-transport SIPA scores (n=36), there was a significant reduction with a mean difference of .30 (95% CI 0.07-0.54) (Figure), 20% of whom decreased from elevated to normal SIPA. Of all patients with post-transport vitals, 43% had a normal SIPA score. 44 patients died in the first 24 hours, of which 29 presented in cardiac arrest and died on arrival. The majority of these deaths (76%) were attributable to traumatic brain injury.

Conclusion: After receiving blood resuscitation in transport, 43% of patients presented with a non-elevated shock index. There was a statistically significant decrease in the SIPA for patients from pre-transport compared to post-transport. Of the patients who died, the majority presented in cardiac arrest with major head injuries. Further study is needed to elucidate the optimal patient population for pre-hospital blood use.