#OA2-AM25-SN-31 - Bringing Whole Blood into Inventory: A Look into the Data of a Level One Pediatric Trauma Center

Pediatric trauma is a leading cause of mortality, with bleeding as a cause of preventable death after injury. In recent years there has been an increase interest in using whole blood at pediatric trauma centers.  Whole blood allows for quicker transfusion of appropriate ratios over individual components. Better hemostasis achievement has also been an attraction of using whole blood over components. However, there is limited data around benefits of whole blood in pediatric resuscitation.  Our study aimed to evaluate our usage of whole blood in the pediatric trauma setting.

Study

Design/Methods:

Low-titer Group O Rh positive Whole Blood (LTOWB) was brought into inventory at a level one pediatric trauma center intended for us in code one trauma patients. Code one trauma patients are defined by the following; intubated, respiratory compromise or insufficiency, cardiac arrest, age appropriate hypotension, Glasgow Coma Scale less than nine attributed to trauma, penetrating injuries or blunt chest trauma. Code one patients were issued either a Trauma Pack which consists of two O negative RBCs and two Plasmas or LTOWB. See Figure A on Trauma Bleeding Resuscitation Protocol. Patient demographics evaluated for the selection of blood products included: gender, weight and age.  The 17 month assessment period started November 2023 when whole blood was introduced and last until March 2025.

Results/Findings:

Over the course of 17 months 155 code one patients presented either to the Emergency Department or directly to the Pediatric Intensive Care Unit. Products were issued to 121 code one trauma patients and 40 patients were issued LTOWB.  Of these, only 11 patients were transfused a total of 18 LTOWB.  22 code one patients did receive product from the Trauma Pack. During the assessment period the average wastage of LTOWB was 65%, resulting in 39 wasted units. Education was provided to all services that interacted with a trauma patient to help decrease wastage and increase confidence in utilizing whole blood. Each code one patient was reviewed in a multidisciplinary meeting to evaluate products transfused to ensure proper usage of Trauma Pack or whole blood. A few cases that were reviewed it was found the Anesthesiologist and Operating Room staff should have utilized whole blood over component therapy. After feedback to those services wastage transiently decreased to 0%; however it increased to 71% owing to a lack of pediatric trauma patients requiring transfusion.

Conclusions:

Due to variability in use, there is a high amount of wastage when LTOWB use is limited to only pediatric trauma patients. Education to providers can decrease wastage. It would also be advisable to reach out to other non-trauma services to assess their interest and ability to utilize whole blood for non-trauma patients. Another viable option would be to set up a system with an adult hospital to allow for rotation of whole blood.