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Massive transfusion and blood product use in the pediatric trauma patient
Jeffrey J Dehmer1, William T Adamson
1Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
Insights
Pediatric trauma patients with hemorrhagic shock lack clear massive transfusion guidelines. This study proposes a pediatric massive transfusion protocol to guide resuscitation and improve outcomes.
Area of Science:
- Pediatric Trauma Care
- Hemorrhagic Shock Management
- Transfusion Medicine
Background:
- Hemorrhagic shock is a critical issue in pediatric trauma.
- Current management relies on crystalloids and blood components.
- Massive transfusion protocols (MTPs) are standard in adults but lack pediatric specificity.
Purpose of the Study:
- To address the absence of specific guidelines for massive transfusion in pediatric trauma.
- To identify key principles for transfusion therapy in pediatric trauma patients.
- To propose a sample pediatric massive transfusion protocol.
Main Methods:
- Review of current adult MTPs and their applicability to pediatric patients.
- Identification of unique considerations for pediatric transfusion.
- Development of a sample MTP tailored for pediatric trauma resuscitation.
Main Results:
- Adult MTPs can serve as a basis for pediatric protocols.
- Specific principles for pediatric transfusion therapy were identified.
- A sample pediatric massive transfusion protocol was outlined.
Conclusions:
- Establishing pediatric-specific massive transfusion protocols is crucial.
- The proposed protocol can guide resuscitation in pediatric trauma.
- Adjunctive therapies like colloids and recombinant activated factor VII warrant consideration.
Abstract:
Hemorrhagic shock in the pediatric trauma patient is an uncommon but fundamental problem for the treating clinician. Current management of hemorrhagic shock involves initial resuscitation with crystalloid fluids followed by infusion of blood components as necessary. In management of the adult trauma patient, many institutions have implemented massive transfusion protocols to guide transfusion in situations requiring or anticipating the use of greater than 10 U of packed red blood cells. In the pediatric population, guidelines for massive transfusion are vague or nonexistent. Adult trauma transfusion protocols can be applied to children until a pediatric protocol is validated. Here, we attempt to identify certain principles of transfusion therapy specific to pediatric trauma and outline a sample pediatric massive transfusion protocol that may be used to guide resuscitation. Also, adjuncts to transfusion, such as colloid fluids, other plasma expanders or hemoglobin substitutes, and recombinant activated factor VII, are discussed.
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