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Damage control resuscitation in pediatric trauma

Meghan Gilley1, Suzanne Beno

  • 1Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Current Opinion in Pediatrics
|February 24, 2018
PubMed

Insights

Damage control resuscitation in pediatric trauma focuses on stabilizing patients while managing hypothermia, coagulopathy, and acidosis. Current evidence suggests cautious fluid use and early blood product transfusion, though optimal ratios require further study.

Area of Science:

  • Pediatric Trauma Care
  • Resuscitation Medicine
  • Hemorrhagic Shock Management

Background:

  • Damage control resuscitation (DCR) is a strategy to stabilize trauma patients, addressing hypothermia, coagulopathy, and acidosis.
  • This review examines DCR in pediatric trauma, emphasizing fluid management strategies.

Observation:

  • Recent studies explore crystalloid resuscitation, balanced blood product transfusion, and hemostatic agents in pediatric trauma.
  • Excessive fluid resuscitation is associated with increased ICU/ventilator days and mortality.
  • Balanced massive transfusion (1:1:1 ratio) benefits in pediatric trauma are not yet established as in adults.
  • Tranexamic acid (TXA) shows promise in pediatric trauma, similar to adult trauma evidence.

Findings:

  • Rapid vascular access and correction of hypothermia and acidosis are critical.
  • Judicious crystalloid use with early blood product administration is recommended for bleeding pediatric trauma patients.
  • Optimal crystalloid volumes and blood product ratios for pediatric trauma remain undetermined.

Implications:

  • This review highlights the need for evidence-based guidelines in pediatric damage control resuscitation.
  • Further research is necessary to define optimal fluid and blood product strategies for pediatric trauma patients.
  • Implementing DCR principles can improve outcomes in critically injured children.
Abstract

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