Pediatric Traumatic Hemorrhagic Shock Consensus Conference Recommendations

Authors

Robert T Russell
Joseph R Esparaz
Michael A Beckwith
Peter J Abraham
Melania M Bembea
Matthew A Borgman
Randall S Burd
Barbara A Gaines
Mubeen Jafri
Cassandra D Josephson
Christine Leeper
Julie C Leonard
Jennifer A Muszynski
Kathleen K Nicol
Daniel K Nishijima
Paul A Stricker
Adam M Vogel
Trisha E Wong
Philip C Spinella

Publication Date

1-1-2023

Journal

The Journal of Trauma and Acute Care Surgery

DOI

10.1097/TA.0000000000003805

PMID

36245074

PMCID

PMC9805499

PubMedCentral® Posted Date

1-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Child, Humans, Shock, Hemorrhagic, Resuscitation, Shock, Traumatic, Fluid Therapy, Hemostatics, trauma, pediatrics, hemorrhage, consensus

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.