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Time is tissue: Barriers to timely transfusion after pediatric injury
Travis M Sullivan1, Waverly V Gestrich-Thompson, Zachary P Milestone
1From the Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC.
Insights
Timely blood transfusion is crucial for children with hemorrhagic shock. Addressing barriers to rapid transfusion may improve outcomes as much as the treatments themselves.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Emergency medicine
Background:
- Hemorrhagic shock in children requires effective interventions like component resuscitation and hemorrhage control.
- While strategies exist, barriers to their timely use and impact on outcomes are understudied.
- Transfusion is infrequent in injured children, limiting understanding of process-related challenges.
Approach:
- This review identifies critical steps for timely blood transfusion in pediatric patients.
- It proposes practical solutions to minimize delays in delivering essential interventions.
- Focuses on the process from transfusion decision to product delivery.
Key Points:
- Barriers to timely transfusion in pediatric hemorrhagic shock are not well understood.
- The process of obtaining and delivering blood products and adjuncts presents challenges.
- Minimizing delays in transfusion is a key factor in improving patient outcomes.
Conclusions:
- Ensuring prompt blood transfusion is vital for pediatric hemorrhagic shock management.
- Addressing logistical and procedural barriers can significantly improve patient survival.
- Timeliness of intervention may be as critical as the interventions themselves.
Abstract:
Strategies to improve outcomes among children and adolescents in hemorrhagic shock have primarily focused on component resuscitation, pharmaceutical coagulation adjuncts, and hemorrhage control techniques. Many of these strategies have been associated with better outcomes in children, but the barriers to their use and the impact of timely use on morbidity and mortality have received little attention. Because transfusion is uncommon in injured children, few studies have identified and described barriers to the processes of using these interventions in bleeding patients, processes that move from the decision to transfuse, to obtaining the necessary blood products and adjuncts, and to delivering them to the patient. In this review, we identify and describe the steps needed to ensure timely blood transfusion and propose practices to minimize barriers in this process. Given the potential impact of time on hemorrhage associated outcomes, ensuring timely intervention may have a similar or greater impact than the interventions themselves.
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