Comparison of Infection Rate in 1:1 vs. 4:1 Packed Red Blood Cell to Fresh Frozen Plasma Transfusion Strategy During Burn Excision
Author(s):
Tina Palmieri, University of CA, Davis & Shriners Hospital for Children Northern CA; Soman Sen, Shriners Hospital for Children Northern California and the University of California Davis; David Greenhalgh, Shriners Hospital for Children Northern California and the University of California Davis
Background: Burn patients lose 2% blood volume per percent burn excised; hence, massive blood loss (>50% total blood volume) frequently occurs during major burn excisions. This prospective randomized controlled trial compared the impact of a 1:1 versus a 4:1 packed red blood cell/fresh frozen plasma (PRBC/FFP) transfusion strategy on infection in children with >20% total body surface area (TBSA) burn excision.
Hypothesis: We hypothesize that patients in the 1:1 group will have a lower incidence of infection
Methods: Children with >20% TBSA burn were randomized to a 1:1 or 4:1 PRBC/FFP ratio during burn excision. Parameters measured on admission included demographics, burn size, and Pediatric Risk of Mortality (PRISM) scores. Total blood products transfused during operative interventions and during hospitalization were recorded. Blood stream infections (BSI), urinary tract infections (UTI), and pneumonia (PNU), were documented using the burn consensus guideline for infection.
Results: A total of 45 children were randomized into the two groups (22 in the 1:1 and 23 in the 4:1 group). Mean age (6.9±0.11 vs. 6.8±0.1 years), total body surface area burn (38.05±0.19 vs. 42.48±0.23%), and admit Pediatric Risk of Mortality Score (9.8 vs. 12.1) did not differ between groups. Children in the 1:1 group received a total of 193 units PRBC and 150 units FFP during hospitalization compared to 332 units PRBC and 59 units FFP in the 1:4 group. Intraoperatively each patient in the 1:1 group received a mean of 4.6±0.95 PRBC and 4.4±0.91 FFP while the 4:1 group received 8.1±2.0 PRBC and 2.8±0.6 FFP. Children in the 1:1 group had an overall lower number of infections (43 vs. 64), fewer BSI (9 vs. 18), PNU (13 vs. 21), and no difference in UTI (14 vs. 15).
Conclusions: During burn excision a 1:1 PRBC/FFP transfusion strategy, compared to a 4:1 strategy, resulted in less PRBC use and a lower incidence of BSI and PNU. Further study is warranted.