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Pediatric traumatic hemorrhagic shock consensus conference recommendations
Robert T Russell1, Joseph R Esparaz, Michael A Beckwith
1From the Division of Pediatric Surgery, Department of Surgery (R.T.R., J.R.E.), University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama; Division of Pediatric Surgery, Department of Surgery (M.A.B.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (P.J.A.), University of Alabama at Birmingham, 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; Departments of Pathology and Laboratory Medicine (C.D.J.) and Pediatrics (C.D.J.), Emory University School of Medicine, Atlanta, Georgia; Department of Surgery (C.L.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Pediatrics (J.C.L.), Division of Emergency Medicine, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio; Division of Critical Care Medicine (J.A.M.), The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio; 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, Perelman School of Medicine, 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; Department of Pathology (T.E.W.), Division of Pediatric Hematology and Oncology, 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.
Insights
Pediatric traumatic hemorrhagic shock management is challenging. This consensus conference provides 21 recommendations on hemostatic resuscitation, prehospital care, and guided resuscitation for pediatric trauma patients.
Area of Science:
- Pediatric Trauma Care
- Hemorrhagic Shock Management
- Evidence-Based Medicine
Background:
- Hemorrhagic shock in pediatric trauma is a significant cause of preventable death.
- High-quality evidence for hemorrhage control and resuscitation in pediatric trauma is limited.
Purpose of the Study:
- To develop clinical recommendations, expert consensus, and good practice statements for managing pediatric traumatic hemorrhagic shock.
- To provide guidance for healthcare providers caring for pediatric trauma patients with hemorrhagic shock.
Main Methods:
- Systematic reviews on six subtopics related to pediatric traumatic hemorrhagic shock.
- A consensus meeting with a multidisciplinary panel of 16 experts.
- Evaluation of literature and development of 21 recommendations (2 clinical, 14 expert consensus, 5 good practice statements).
Main Results:
- 21 recommendations were generated covering hemostatic resuscitation, prehospital care, and guided resuscitation strategies.
- Recommendations address blood product use, fluid resuscitation, tourniquet application, and airway/blood pressure management.
- Guidance is provided on conventional coagulation tests versus thromboelastography-guided resuscitation.
Conclusions:
- The consensus conference systematically evaluated literature to provide evidence-based guidance.
- Recommendations aim to improve the care of pediatric trauma patients experiencing hemorrhagic shock.
- Multidisciplinary input ensures comprehensive and practical recommendations for clinical practice.
Abstract:
Hemorrhagic shock in pediatric trauma patients remains a challenging yet preventable cause of death. There is little high-quality evidence available to guide specific aspects of hemorrhage control and specific resuscitation practices in this population. We sought to generate clinical recommendations, expert consensus, and good practice statements to aid providers in care for these difficult patients.The Pediatric Traumatic Hemorrhagic Shock Consensus Conference process included systematic reviews related to six subtopics and one consensus meeting. A panel of 16 consensus multidisciplinary committee members evaluated the literature related to 6 specific topics: (1) blood products and fluid resuscitation for hemostatic resuscitation, (2) utilization of prehospital blood products, (3) use of hemostatic adjuncts, (4) tourniquet use, (5) prehospital airway and blood pressure management, and (6) conventional coagulation tests or thromboelastography-guided resuscitation. A total of 21 recommendations are detailed in this article: 2 clinical recommendations, 14 expert consensus statements, and 5 good practice statements. The statement, the panel's voting outcome, and the rationale for each statement intend to give pediatric trauma providers the latest evidence and guidance to care for pediatric trauma patients experiencing hemorrhagic shock. With a broad multidisciplinary representation, the Pediatric Traumatic Hemorrhagic Shock Consensus Conference systematically evaluated the literature and developed clinical recommendations, expert consensus, and good practice statements concerning topics in traumatically injured pediatric patients with hemorrhagic shock.
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