Hemostatic Resuscitation of Pediatric Trauma Patients During Air Medical Transport: A Retrospective Matched Cohort Study

• Published in: Air medical journal 2021-09, Vol.40 (5), p.344-349
• Main Authors: Van Dijck, Cedric P., Stansbury, Lynn G., Latimer, Andrew J., Butler, Elissa K., Nathwani, Rajen, Wall, Jessica, Utarnachitt, Richard B., Vavilala, Monica S., Hess, John R.
• Format: Article
• Language: English
• Subjects: Health administration
• ISSN: 1067-991X; 1532-6497
• DOI: 10.1016/j.amj.2021.04.004

The objective of this study was to examine an academic air ambulance service's experience with prehospital transfusion of plasma and red blood cells in pediatric trauma for evidence of efficacy on the treatment of shock and coagulopathy. All trauma patients < 18 years old transfused during transport by the University of Washington Airlift Northwest (Airlift) air medical transport service to Harborview Medical Center, Seattle, WA, were identified. Controls were matched 1:1 from pediatric trauma patients transported by Airlift before transfusion support became available. Demographics, injury scores, emergency department admission and interval laboratory values, blood product use, and hospital outcome measures were registered. Seventeen cases met the inclusion criteria and were matched by age and Injury Severity Score to 17 control patients (mean age = 10.5 vs. 10.9 years; New Injury Severity Score, 37 vs. 40.7). No significant differences in vital signs, shock index, or mortality were observed. Cases received less in-flight crystalloid (4.3 mL/kg vs. 16.9 mL/kg, P = .004), had higher admission fibrinogen levels (238 vs. 148mg/dL, P = .007), and shorter time to normalization of the international normalized ratio (6.4 vs. 19.1 hours, P = .04). In this small series, hemostatic resuscitation during air medical transport was associated with less crystalloid administration and better support of coagulation indices.