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Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
Published on: November 3, 2023
Pediatric traumatic hemorrhagic shock consensus conference research priorities
Robert T Russell1, Melania M Bembea, Matthew A Borgman
1From the Department of Surgery (R.T.R.), Division of Pediatric Surgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama; Division of Anesthesiology and Critical Care Medicine (M.M.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics (M.A.B.), Brooke Army Medical Center, Uniformed Services University; Division of Trauma and Burn Surgery (R.S.B.), Children's National Hospital, Washington, DC; Department of Surgery (B.A.G.), University of Pittsburgh School of Medicine, UPMC Children's Hospital, Pittsburgh, Pennsylvania; Division of Pediatric Surgery (M.J.), Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon; Department of Oncology (C.D.J.), Sydney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Cancer and Blood Disorders Institute (C.D.J.), Johns Hopkins All Children's Hospital, St. Petersburg, Florida; Department of Surgery (C.M.L.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Pediatrics (J.C.L.), Division of Emergency Medicine, Division of Critical Care Medicine (J.A.M.), and Department of Pathology and Laboratory Medicine (K.K.N.), Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Department of Emergency Medicine (D.K.N.), Davis School of Medicine, University of California, Sacramento, California; Department of Anesthesiology and Critical Care (P.A.S.), The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Divisions of Pediatric Surgery (A.M.V.) and Critical Care (A.M.V.), Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Division of Pediatric Hematology and Oncology (T.E.W.), and Department of Pathology (T.E.W.), Oregon Health and Science University, Portland, Oregon; and Department of Surgery and Critical Care Medicine (P.C.S.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Background:
Traumatic injury is the leading cause of death in children and adolescents. Hemorrhagic shock remains a common and preventable cause of death in the pediatric trauma patients. A paucity of high-quality evidence is available to guide specific aspects of hemorrhage control in this population. We sought to identify high-priority research topics for the care of pediatric trauma patients in hemorrhagic shock.
Methods:
A panel of 16 consensus multidisciplinary committee members from the Pediatric Traumatic Hemorrhagic Shock Consensus Conference developed research priorities for addressing knowledge gaps in the care of injured children and adolescents in hemorrhagic shock. These ideas were informed by a systematic review of topics in this area and a discussion of these areas in the consensus conference. Research priorities were synthesized along themes and prioritized by anonymous voting.
Results:
Eleven research priorities that warrant additional investigation were identified by the consensus committee. Areas of proposed study included well-designed clinical trials and evaluations, including increasing the speed and accuracy of identifying and treating hemorrhagic shock, defining the role of whole blood and tranexamic acid use, and assessment of the utility and appropriate use of viscoelastic techniques during early resuscitation. The committee recommended the need to standardize essential definitions, data elements, and data collection to facilitate research in this area.
Conclusion:
Research gaps remain in many areas related to the care of hemorrhagic shock after pediatric injury. Addressing these gaps is needed to develop improved evidence-based recommendations for the care of pediatric trauma patients in hemorrhagic shock.
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