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Research Snapshot Theater: Pediatrics, Future of Critical Care

(795) Utilization of Viscoelastic Testing to Optimize Pediatric Burn-Related Transfusions

Tuesday, January 23, 2024
8:45 AM – 9:45 AM MT
Location: Connections Central - RST 03

    First Author(s)

  • Alexandra Halevi, MD,

    Clinical Fellow - Surgical Critical Care
    Brown University School of Medicine/Rhode Island Hospital
    Providence, Rhode Island

    • Co-Author(s)

  • ST

    Sundeep Tumber, DO

    Chief of Anesthesiology
    Shriner's Hospital for Children, United States

  • CS

    Casey Stondell, MD

    Anesthesiology
    Shriner's Hospital for Children, United States

  • SS

    Soman Sen, MD

    Professor, Burn Surgery
    Shriners Hospital For Children Northern California, United States

Introduction: Intraoperative acute blood loss in severe pediatric burns (total body surface area [TBSA] > 20%) is an ongoing problem. Children can lose up to 2 percent of blood volume for every percent of total body surface area excised. Furthermore, severely burned patients can develop clinically relevant coagulopathies that are not reliably identified by conventional assays. We utilized real-time point-of-care (POC) viscoelastic testing (VET) to guide intra-operative transfusions in a pediatric burn population.

Methods: We retrospectively reviewed data from January 1, 2020 to December 31, 2020 for pediatric surgical procedures involving burn excision and grafting requiring intraoperative allogenic blood transfusions at a tertiary care center. The objective of this study was to compare the total volume of allogenic blood product administration in patients managed with POC VET vs conventional lab-based coagulation assays. Patients < 18 years of age with TBSA > 20% were included. Data were compared using students t-tests, p < 0.05.

Results: A total of 36 patients were included, 27 controls and 9 who were managed with VET. Average age, weight, percent TBSA, percent TBSA excised were not statistically different between the two groups. Percentage of blood volume loss and overall allogenic blood transfusion administration (mL/kg) were similar between the groups. However, there was a significant difference in the volume of fresh frozen plasma (FFP) administered (10 mL/kg for the control group vs 0 mL/kg for the VET group, p = 0.04), (Table 1). Neither group had clinically significant bleeding complications.

Conclusions: In this retrospective study, we found that patients managed with POC VET received significantly less FFP compared to those managed with conventional lab-based coagulation assays and avoided clinically significant post-op bleeding complications. Additional research is needed to compare long-term clinical outcomes between these two groups.