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Pediatric trauma and resuscitation: optimizing care in an evolving landscape
Carl L McMullen1, David Levin2,3, Asheen Rama4
1Division of Pediatric Anesthesiology, Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.
Insights
Pediatric firearm injuries are rising, increasing mortality and massive transfusion needs. Prompt hemostatic resuscitation, considering unique pediatric coagulation, is crucial for survival.
Area of Science:
- Pediatric Trauma Surgery
- Hemorrhagic Shock Management
- Coagulation Physiology
Background:
- Firearm-related injuries present a growing mortality risk in children.
- Pediatric trauma patients exhibit unique coagulation system characteristics.
- Effective management of traumatic hemorrhage in children is critical.
Purpose of the Study:
- To review current trends in pediatric firearm injury patterns.
- To discuss the pediatric coagulation system's unique aspects.
- To outline essential components of hemostatic resuscitation in pediatric trauma.
Main Methods:
- Review of pediatric injury patterns and mortality trends.
- Analysis of pediatric coagulation system physiology.
- Summary of hemostatic resuscitation strategies for children.
Main Results:
- Firearm-associated trauma correlates with increased pediatric mortality and massive transfusion rates.
- Platelet dysfunction and hypocalcemia complicate resuscitation, increasing transfusion needs.
- Low-titer group O whole blood demonstrates improved outcomes in pediatric coagulopathy and shock.
Conclusions:
- Prompt hemostatic resuscitation is vital for life-threatening pediatric hemorrhage.
- Massive transfusion protocols must address trauma-induced coagulopathy and pediatric-specific physiology.
- Standardization of pediatric resuscitation practices requires continued research.
Purpose Of Review:
Penetrating firearm-related injury has increased mortality rates in children in the USA. This article summarizes trends in pediatric injury patterns, the unique coagulation system of infants, and key components of hemostatic resuscitation in children.
Recent Findings:
Firearm-associated penetrating trauma increased mortality and led to higher rates of pediatric massive transfusions. Patients may be the victim of previous gun violence or live with an adult who purchased a firearm for the first time during the COVID-19 pandemic. Platelet dysfunction and hypocalcemia are important considerations that may lead to higher transfusion requirements if not addressed. Pediatric massive transfusion protocols have become more standardized, and the use of whole blood has increased. Low-titer group O whole blood has shown benefit to improve coagulopathy and shock-associated indices when compared with conventional component therapy.
Summary:
Traumatic hemorrhage is potentially life-threatening in children and requires prompt hemostatic resuscitation. Massive transfusion protocols that target trauma-induced coagulopathy and account for the unique pediatric coagulation system are imperative. Ongoing and future research is important to standardize pediatric resuscitation practices.
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