(747) Monitoring Compliance and Practice Patterns Following TAXI Guideline Publication

Introduction: Despite a growing body of literature supporting restrictive transfusion strategies in critically ill pediatric patients, great variability around transfusion practices exists across pediatric intensive care units (PICU). In 2018, the “Transfusion and Anemia eXpertise Initiative” (TAXI) released guidelines for red blood cell (RBC) transfusion in critically ill children, stating that hemodynamically stable children should not be transfused for hemoglobin (Hgb) greater than 7.0 g/dL, or 9.0 g/dL for those with single ventricle physiology. We aim to assess the long-term adherence to the TAXI guidelines within a single center’s PICU and compare outcomes in patients who received transfusions in accordance with the published recommendations.

Methods: A retrospective review of critically ill children, ages birth to 18 years, who were hemodynamically stable and admitted to the PICU between 2019-2021, who received ≥ 1 RBC transfusion. Patients on extracorporeal membrane oxygenation or ventricular assist devices were excluded from the review.

Results: 300 patient encounters, and > 2000 RBC transfusions were included in the review. Compliance was assessed using a Hgb threshold of 7.0 g/dL in hemodynamically stable patients, or 9.0 g/dL in those with single ventricle physiology. Estimated compliance within PICU patients receiving RBC transfusions was 60%. Estimated compliance within the single ventricle subset was much lower at 20%. Reasons listed for non-compliance included hypoxia and coagulopathy. Subgroup analysis of patients admitted with sepsis, traumatic brain injury, trauma, and congenital heart disease, showed lower compliance in those with congenital heart disease and lower compliance in patients with sepsis, with 60% compliant vs 40% non-compliant. Frequent RBC transfusions were associated with longer hospital stays and longer days on mechanical ventilation.

Conclusions: Following the publishing of the 2018 TAXI transfusion guidelines, our PICU has shown mixed results in adopting restrictive transfusion practices. Our PICU overall shows good compliance with these guidelines, while our single ventricle population shows less compliance with these recommendations with an overall trend to transfuse earlier.