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Outcomes Related to the Use of Frozen Plasma or Pooled Solvent/Detergent-Treated Plasma in Critically Ill Children*

Camazine, Maraya N. BS1; Karam, Oliver MD, PhD2,3; Colvin, Ryan MPH1; Leteurtre, Stephane MD, PhD3,4; Demaret, Pierre MD, MSc3,5; Tucci, Marisa MD6; Muszynski, Jennifer A. MD7; Stanworth, Simon MD8,9; Spinella, Philip C. MD, FCCM1on behalf of the PlasmaTV Investigators and the Pediatric Critical Care Blood Research Network (Blood Net)

Pediatric Critical Care Medicine: May 2017 - Volume 18 - Issue 5 - p e215–e223
doi: 10.1097/PCC.0000000000001149
Online Clinical Investigations

Objective: To determine if the use of fresh frozen plasma/frozen plasma 24 hours compared to solvent detergent plasma is associated with international normalized ratio reduction or ICU mortality in critically ill children.

Design: This is an a priori secondary analysis of a prospective, observational study. Study groups were defined as those transfused with either fresh frozen plasma/frozen plasma 24 hours or solvent detergent plasma. Outcomes were international normalized ratio reduction and ICU mortality. Multivariable logistic regression was used to determine independent associations.

Setting: One hundred one PICUs in 21 countries.

Patients: All critically ill children admitted to a participating unit were included if they received at least one plasma unit during six predefined 1-week (Monday to Friday) periods. All children were exclusively transfused with either fresh frozen plasma/frozen plasma 24 hours or solvent detergent plasma.

Interventions: None.

Measurements and Main Results: There were 443 patients enrolled in the study. Twenty-four patients (5%) were excluded because no plasma type was recorded; the remaining 419 patients were analyzed. Fresh frozen plasma/frozen plasma 24 hours group included 357 patients, and the solvent detergent plasma group included 62 patients. The median (interquartile range) age and weight were 1 year (0.2–6.4) and 9.4 kg (4.0–21.1), respectively. There was no difference in reason for admission, severity of illness score, pretransfusion international normalized ratio, or lactate values; however, there was a difference in primary indication for plasma transfusion (p < 0.001). There was no difference in median (interquartile range) international normalized ratio reduction, between fresh frozen plasma/frozen plasma 24 hours and solvent detergent plasma study groups, –0.2 (–0.4 to 0) and –0.2 (–0.3 to 0), respectively (p = 0.80). ICU mortality was lower in the solvent detergent plasma versus fresh frozen plasma/frozen plasma 24 hours groups, 14.5% versus 29.1%%, respectively (p = 0.02). Upon adjusted analysis, solvent detergent plasma transfusion was independently associated with reduced ICU mortality (odds ratio, 0.40; 95% CI, 0.16–0.99; p = 0.05).

Conclusions: Solvent detergent plasma use in critically ill children may be associated with improved survival. This hypothesis-generating data support a randomized controlled trial comparing solvent detergent plasma to fresh frozen plasma/frozen plasma 24 hours.

1Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.

2Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland.

3University of Lille-Nord-de-France, EA 2694—Santé Publique: épidémiologie et qualité des soins, F-59000 Lille, France.

4Pediatric Intensive Care Unit, Centre Hospitalier Universitaire (CHU) Lille, F-59000 Lille, France.

5Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Liège, Belgium.

6Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, QC, Canada.

7Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH.

8NHS Blood and Transplant/Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.

9University of Oxford, Oxford, United Kingdom.

*See also p. 496.

PlasmaTV Investigators are listed in the Acknowledgments section.

Dr. Spinella received funding from consulting for Octapharma, Cerus, and TerumoBCT. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Philip C. Spinella, MD, FCCM, Washington University School of Medicine at Washington University Medical Center, Northwest Tower Campus Box 8116, 660 South Euclid Avenue, St. Louis, MO, 63110. E-mail: Spinella_p@kids.wustl.edu

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies