Association of Cryoprecipitate use with survival after major
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The results of this study by JAMA Surgery suggest that cryoprecipitate should be included in massive transfusion protocols for injured children with large-volume blood loss.

The objective of this study was to determine whether cryoprecipitate use for injured children who receive massive transfusion is associated with lower mortality.

This retrospective cohort study included injured patients. Patients were aged 18 years or younger and had received a massive transfusion, which was defined as at least 40 mL/kg of total blood products in the first 4 hours after emergency department arrival. The propensity score accounted for age, sex, race/ethnicity, injury type, payment type, Glasgow Coma Scale score, hypoxia, hypotension, assisted respirations, chest tube status, Injury Severity Score, the total volume of blood products received, hemorrhage control procedure, hospital size, academic status, and trauma center designation.

Of the 2387 injured patients who received a massive transfusion, 1948 patients were eligible for analysis. A total of 541 patients received cryoprecipitate.

--After propensity score weighting, patients who received cryoprecipitate had a significantly lower 24-hour mortality when compared with those who did not.

--Moreover, cryoprecipitate use was associated with a significantly lower 7-day mortality but only in children with penetrating trauma and those transfused at least 100 mL/kg of total blood products.

In this cohort study, early use of cryoprecipitate was associated with lower 24-hour mortality among injured children who required massive transfusion. The benefit of cryoprecipitate appeared to persist for 7 days only in those with penetrating trauma and in those who received an extremely large-volume transfusion.