UMEM Educational Pearls

Category: Trauma

Title: Challenges of resuscitation in pediatric trauma

Keywords: trauma, pediatrics, resuscitation, MTP, MHP (PubMed Search)

Posted: 10/14/2023 by Robert Flint, MD (Emailed: 10/22/2023) (Updated: 2/23/2024)
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This excellent review article discussing damage control resuscitation in traumatically injured children highlights several points including:

 

-”Damage-control resuscitation (DCR) consists of rapid control of bleeding, avoidance of hemodilution, acidosis, and hypothermia; early empiric balanced transfusions with red blood cells, plasma and platelets, or whole blood when available, and the use of intravenous or mechanical hemostatic adjuncts when indicated.”

 

-”he 30-day mortality in children with traumatic hemorrhagic shock is estimated to be 36% to 50% compared with the 25% reported mortality in similar adults. The early stages of hemorrhagic shock after injury in children can be more challenging to recognize because of their remarkable compensatory mechanisms. In children unlike adults, blood pressure alone is an insensitive indicator of hemorrhagic shock as hypotension is a late sign often not occurring until blood volume is reduced by >40%.”

 

-”Based on the current literature, the challenges health care providers must focus on are the early recognition of shock in the pediatric patient, moving the hemostatic resuscitation forward to the prehospital phase when feasible, improvement in times to first blood product, balanced resuscitation and efficiency of massive transfusion protocols (MTPs).”

 

References

Russell, Robert T. MD, MPH; Leeper, Christine M. MD; Spinella, Philip C. MD. Damage-control resuscitation in pediatric trauma: What you need to know. Journal of Trauma and Acute Care Surgery 95(4):p 472-480, October 2023. | DOI: 10.1097/TA.0000000000004081