Pediatric trauma transfusion and cognitive aids.
Adult current practice and emerging trends around transfusion relating to trauma and, by inference, massive blood loss from surgical practice are reviewed with reference to paediatric practice.
This review promises much from the title but delivers little new information. This is no fault of the author, rather a reflection of the paucity of paediatric-specific research in the field of trauma transfusion.
However, there are some useful take-home messages:
- Keep them warm: there is a 10% decrease in clotting factors for every degree drop from normothermia
- Use a 1:1:1 ratio of packed red blood cells to FFP to platelets
- Massive Transfusion Protocols may be better in a “human factors” format – an example is shown in the article
- Deliberate hypotension may be hazardous in children (childrens’ baseline BPs are already close to the limits of cerebral autoregulation)
- Tranexamic acid decreases mortality for blast and penetrating trauma in children – more studies are needed in blunt trauma
- Factor VIIa reduces blood product administration – at the expense of thrombotic complications in children – Thromboelastography may be able to tell us who to use FVIIa in the future.
Reviewed by: Chris Smit