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Balanced resuscitation: application to the paediatric trauma population

Nathan Georgette1, Galina Lipton, Joyce Li

  • 1Boston Children's Hospital, Division of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.

Current Opinion in Pediatrics
|February 10, 2023
PubMed

Insights

Trauma-induced coagulopathy (TIC) in children requires balanced resuscitation. Early blood products, particularly a 1:1 plasma to pRBC ratio, may improve outcomes, but more research is needed.

Area of Science:

  • Pediatric Trauma Care
  • Hemorrhagic Shock Management
  • Coagulopathy Research

Background:

  • Trauma is a leading cause of death in children over five years old.
  • Trauma-induced coagulopathy (TIC) is a significant factor in early mortality.
  • Balanced resuscitation strategies aim to mitigate TIC effects.

Approach:

  • Review of current evidence on balanced resuscitation in pediatric trauma.
  • Analysis of crystalloid fluid versus early blood product administration.
  • Evaluation of massive transfusion protocols (MTP) and optimal blood product ratios.

Key Points:

  • Crystalloid fluids may be associated with adverse events in pediatric trauma.
  • Optimal implementation of early blood products and MTP indications require further investigation.
  • A 1:1 plasma to packed red blood cell (pRBC) ratio is suggested but needs prospective validation.

Conclusions:

  • Balanced resuscitation with minimal crystalloids and early blood products shows improved morbidity in pediatric trauma.
  • While MTPs with a 1:1 plasma:pRBC ratio may enhance morbidity, mortality benefits are unclear.
  • Further research is essential to establish definitive mortality benefits and optimal protocols.
Abstract

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