Use of rapid infusion devices for transfusion in childhood trauma cases

A transfusion medicine physician has a question regarding pediatric trauma transfusion practice. More specifically, she reports that her community level 1 trauma center uses uncrossmatched Optisol red cells (neither fresh nor irradiated) as the emergency stock supply. In ADULT trauma cases, a rapid infusion device (a Sims level 1 infuser) is routinely used. The inquiring blood banker wants to know what is the practice among hospitals that care for pediatric trauma patients? Is there a weight limit under which such a rapid infuser should not be used? The inquiring colleague is not concerned about NEONATAL or ADULT transfusion guidelines. Rather, she is only concerned with guidelines for the small child, and hopes for clear guidance.

ADDENDA October 2, 2008

1. A physician who is currently in a Transfusion Medicine Fellowship at an academic medical center located on the East Coast of the US wonders if any pediatric level I trauma centers have trauma protocols that they would be willing to share. She also wonders how these protocols differ from the adult protocols? Do the pediatric trauma protocols incorporate varying size and age of the pediatric population? At her training institution, they do NOT have a set algorithm or trauma protocol for children. Currently, the pediatric trauma surgeon calls the blood bank and asks for X number of units of RBC, platelets, and/or FFP, based on each individual case presentation.

ADDENDA Nov. 4, 2008

2. Dr. Theresa Nester, who works at the Puget Sound Blood Center (attribution used with permission), has graciously provided the attached pediatric transfusion protocol which includes a section that addresses transfusion in trauma. She comments that she sent is sharing this protocol in hopes that it is helpful for the people who recently posed questions about pediatric trauma. She acknowledges that she searched high and low for a guideline on the use of rapid infusion devices in small children. The only one she could find was in nursing critical care guidelines, which suggested not using this type of device in children less than 20 Kg. Considering that a level 1 infusion device can transfuse 1 unit of RBCs in about 2 minutes, one can do the math based on weight of the child to determine plasma K levels. Recall that AS solutions will be lower in potassium than CPD. For children less than 4 months, she would still try to get them fresh, CPD or CPDA, irradiated, CMV safe units.

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