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SN4-25: Recent Studies from the Pediatric Critical Care Blood Research Network (BloodNet)


Oct 20, 2019 2:00pm ‐ Oct 20, 2019 3:30pm

Description

Recent Studies from the Pediatric Critical Care Blood Network (BloodNet)
During this session, we will present the results from three major studies recently conducted in critically ill. None of these studies have yet be published. However, as we expect the manuscripts to be published these next few months, the results will be presented at the AABB meeting.

Age of Blood in Children in Pediatric Intensive Care Units (ABC-PICU)
There is a widely held belief that fresher red blood cells (RBCs) possibly benefit one of the most vulnerable populations of patients needing transfusions – critically ill children. In fact, transfusion practices for certain pediatric subpopulations involve routine transfusion of fresher RBCs without evidence that this is best practice. The Age of Blood in Children in Pediatric Intensive Care Units (ABC-PICU) trial is a randomized double blinded controlled trial that aimed to study subject allocated to receive either RBCs of decreased storage duration (≤7 days) or standard issue RBCs (the oldest available in inventory). The RCT recruited 1538 patients from 52 sites. The primary outcome is the percentage of critically ill children who develop New or Progressive Multiple Organ Dysfunction Syndrome. Secondary outcomes include the Pediatric Logistic Organ Dysfunction score, mortality at PICU discharge, in-hospital 28-day outcome, 90-day mortality, and duration of ICU stay and mechanical ventilation.

Massive Transfusion in Children (MATIC)
The Massive Transfusion in Children (MATIC) study is a high quality, multi-center, prospective observational study for children who have an MTP activated for life-threatening bleeding. The objective of this study is to investigate the epidemiology, resuscitation practices, and outcomes in children with severe bleeding from all causes. The study enrolled 500 children internationally and categorized the cause of bleeding into 3 main groups; trauma, operative, and medical. Therapeutic interventions examined for associations with outcomes enrolled in this study include blood product ratios, timing of blood use, coagulation factor concentrates, and antifibrinolytics. Organ failure, mortality, and cause of mortality are clinical outcomes that were examined in this study.

Biologic Efficacy Targets for Transfusion (BETTr)
Description: Physiologic rationale and preliminary evidence will be presented supporting prioritization of anemia intolerance, rather than anemia degree (per se), as the principle indication for transfusion. A system for quantifying (and forecasting ability to sustain) the physiologic compensation for anemia will be presented, along with evidence that this system greatly enriches transfusion decision making that is based upon Hb thresholds alone. A system for facile implementation of this system into the natural flow of care delivery will also be presented.

Learning Objectives:

  • Investigate the impact of the length of storage of RBC units on clinical outcomes, in critically ill children.
  • Describe the epidemiology, resuscitation practices, and outcomes in children with severe bleeding.
  • Identify the physiological mechanisms that control oxygen delivery and the concept of quantifiable anemia tolerance as principal indication for transfusion.

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