[Damage control resuscitation in pediatric severe trauma]

Area of Science:

• Pediatric Trauma Care
• Resuscitation Medicine
• Emergency Medicine

Background:

• Trauma is a leading cause of death in children, with many fatalities preventable through effective resuscitation.
• Optimal and timely resuscitation can significantly reduce early and late deaths and sequelae from pediatric trauma.

Purpose of the Study:

• To review the applicability of damage control resuscitation (DCR) in severe pediatric trauma.
• To emphasize the medical management aspects of DCR in pediatric patients.

Main Methods:

• Literature search conducted on PubMed, Cochrane Library, and Google Scholar.
• Keywords included trauma, polytrauma, resuscitation, damage-control, fluids, permissive hypotension, coagulopathy, massive transfusion, and children.

Main Results:

• Damage control resuscitation (DCR) principles are adaptable to severe pediatric trauma, considering unique pediatric physiology and anatomy.
• DCR focuses on managing the lethal triad: coagulopathy, acidosis, and hypothermia, often associated with damage control surgery.
• Initial treatment strategies reviewed include limiting crystalloid fluids, applying permissive hypotension, and implementing hemostatic resuscitation.

Conclusions:

• Further research is needed to define the precise role of permissive hypotension in pediatric trauma.
• Optimal ratios of blood products for resuscitation require further investigation.
• Developing strategies to predict and manage massive transfusion protocols in pediatric trauma is crucial.