Title

Damage control resuscitation permissive hypotension and massive transfusion protocols

Document Type

Journal Article

Publication Date

1-1-2014

Journal

Pediatric Emergency Care

Volume

30

Issue

9

DOI

10.1097/PEC.0000000000000217

Keywords

coagulopathy; damage-control resuscitation; hemorrhagic shock; massive transfusion protocol; permissive hypotension

Abstract

Copyright © 2014 by Lippincott Williams & Wilkins. Evidence for changes in adult trauma management often precedes evidence for changes in pediatric trauma management. Many adult trauma centers have adopted damage-control resuscitation management strategies, which target the metabolic syndrome of acidosis, coagulopathy, and hypothermia often found in severe uncontrolled hemorrhage. Two key components of damage-control resuscitation are permissive hypotension, which is a fluid management strategy that targets a subnormal blood pressure, and hemostatic resuscitation, which is a transfusion strategy that targets coagulopathy with early blood product administration. Acceptance of damage-control resuscitation strategies is reflected in recent changes in the American College of Surgeons' Advanced Trauma Life Support curriculum; the most recent edition has decreased its initial fluid recommendation to 1 L from 2 L, and it now recommends early administration of blood products without specifying any specific ratio. These recommendations are not advocating permissive hypotension or hemostatic resuscitation directly but represent an initial step toward limiting fluid resuscitation and using blood products to treat coagulopathy earlier. Evidence for permissive hypotension exists in animal studies and few adult clinical trials. There is no evidence to support permissive hypotension strategies in pediatrics. Evidence for hemostatic resuscitation in adult trauma management is more comprehensive, and there are limited data to support its use in pediatric trauma patients with severe hemorrhage. Additional studies on the management of children with severe uncontrolled hemorrhage are needed..

This document is currently not available here.

Share

COinS