Activation of the protocol of massive hemorrhage in a pediatric university hospital. Retrospective analysis of two years
Introduction and Objectives: The pediatric patient has a limitation of adaptation to hypovolemia, which is the origin of 12% of cardiorespiratory arrest in children. For this reason, it is essential to develop protocols that facilitate the unification of criteria and communication between services and professionals and give a rapid response to a critical situation such as massive hemorrhage (MH).
We present the protocol of MH of La Paz Children´s University Hospital and the analysis of its activation in a two years period.
Materials and Methods: A retrospective descriptive analysis of the activation of MH protocol of La Paz Children´s University Hospital between 2013 and 2014. Data were collected on the number of patients per year and the number of concentrated red blood cells.
We also present the hospital protocol based on improved communication with the blood bank, the use of a hemostatic resuscitation protocol through the administration of component packages and the use of point of care monitoring using ROTEM™. 
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Results and Discussion: The analysis of the first two years of operation of the massive hemorrhage protocol of the La Paz children´s hospital shows a total of 9 activations (5 in 2013 and 4 in 2014). The mean and standard deviation of RBC transfused was 7.6 (± 6.4) and 6 (± 1.6) units per patient respectively, with a maximum of 19 units and a minimum of 4.
Like what has been reported in several studies, the proportion of RBC is higher than that of other blood components (FFP and PC), whose transfusion can sometimes be reduced or even avoided using factor concentrates (fibrinogen or prothrombin complex).
Conclusions: Every hospital must have a protocol of massive hemorrhage adapted to its characteristics that allows a coordinated and rapid response that corrects and avoids, as much as possible, hypovolemia and coagulopathy.