Damage Control Resuscitation in Pediatric Trauma Patients

Sadaf Noureen; Mahwish Noor Ul Haq; Muhammad Sharif; Umm-E-Rubab; Muhammad Habib Javed; Nimra Fatima

doi:10.70749/ijbr.v3i4.1072

Authors

Sadaf Noureen Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.
Mahwish Noor Ul Haq Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.
Muhammad Sharif Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.
Umm-E-Rubab Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.
Muhammad Habib Javed Department of Paediatric Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.
Nimra Fatima Department of Thoracic Surgery, Mayo Hospital, Lahore, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i4.1072

Keywords:

Massive Transfusion Protoco, Thromboembolic Events, Pediatric

Abstract

Background: Pediatric Damage control resuscitation and massive blood transfusions are widely practiced globally, yet there is a lack of comprehensive data on pediatric massive transfusion protocols (MTPs) and their outcomes. We present a pediatric DCR and evaluate its effects on morbidity and mortality. Methods: Using a Randomized Control Trial, we gathered the data on all pediatric trauma patients who presented from January 2022 to September 2022 in emergency department of pediatric surgery, Mayo hospital, Lahore. Our study encompassed patients who received blood products according to the DCR protocol as well as patients who were transfused crystalloids and whole blood according to conventional protocol. Outcomes between groups were compared. Results: A total of 58 patients were included, with 29 patients in the DCR group and 29 patients receiving blood according to conventional protocol (control group). Mortality was significantly different between groups.( 6.89 % in DCR group versus 27.58 % in control group, p-value : 0.027) Injury Severity Score for the two groups was not statistically different.( 20 ± 11 in DCR group vs 20 ± 12) Incidence of thromboembolic complications was found to be equal in both groups.(3.44% in each group) Coagulopathy, indicated by partial thromboplastin time (PTT) greater than 36, was linked to crystalloids and whole blood use.( 3.44% in DCR group versus 20.69% in control group, p-value : 0.044). Conclusion: DCR have been widely implemented in hospitals to lessen coagulopathy associated with hemorrhage. Blood transfusion via DCR is associated with decreased mortality and decrease incidence of coagulopathy. These findings endorse the implementation of pediatric DCR and highlight the need for additional research to understand its key factors and effects.

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References

Roquet, F., Neuschwander, A., Hamada, S., Favé, G., Follin, A., Marrache, D., Cholley, B., & Pirracchio, R. (2019). Association of early, high plasma-to–red blood cell transfusion ratio with mortality in adults with severe bleeding after trauma. JAMA Network Open, 2(9), e1912076. https://doi.org/10.1001/jamanetworkopen.2019.12076

Kauvar, D. S., Lefering, R., & Wade, C. E. (2006). Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. Journal of Trauma: Injury, Infection & Critical Care, 60(6), S3-S11. https://doi.org/10.1097/01.ta.0000199961.02677.19

Girard, E., Jegousso, Q., Boussat, B., François, P., Ageron, F., Letoublon, C., & Bouzat, P. (2019). Preventable deaths in a French regional trauma system: A six-year analysis of severe trauma mortality. Journal of Visceral Surgery, 156(1), 10-16. https://doi.org/10.1016/j.jviscsurg.2018.05.002

Sanddal, T. L., Esposito, T. J., Whitney, J. R., Hartford, D., Taillac, P. P., Mann, N. C., & Sanddal, N. D. (2011). Analysis of preventable trauma deaths and opportunities for trauma care improvement in Utah. Journal of Trauma: Injury, Infection & Critical Care, 70(4), 970-977. https://doi.org/10.1097/ta.0b013e3181fec9ba

Spinella, P. C., Pidcoke, H. F., Strandenes, G., Hervig, T., Fisher, A., Jenkins, D., Yazer, M., Stubbs, J., Murdock, A., Sailliol, A., Ness, P. M., & Cap, A. P. (2016). Whole blood for hemostatic resuscitation of major bleeding. Transfusion, 56(S2). https://doi.org/10.1111/trf.13491

Spinella, P. C., & Doctor, A. (2014). Role of transfused red blood cells for shock and Coagulopathy within remote damage control resuscitation. Shock, 41(Supplement 1), 30-34. https://doi.org/10.1097/shk.0000000000000089

Bradley, M., Nealeigh, M., Oh, J. S., Rothberg, P., Elster, E. A., & Rich, N. M. (2017). Combat casualty care and lessons learned from the past 100 years of war. Current Problems in Surgery, 54(6), 315-351. https://doi.org/10.1067/j.cpsurg.2017.02.004

Kragh, J. F., Littrel, M. L., Jones, J. A., Walters, T. J., Baer, D. G., Wade, C. E., & Holcomb, J. B. (2011). Battle casualty survival with emergency tourniquet use to stop limb bleeding. The Journal of Emergency Medicine, 41(6), 590-597. https://doi.org/10.1016/j.jemermed.2009.07.022

Blackbourne, L. H., Baer, D. G., Eastridge, B. J., Kheirabadi, B., Kragh, J. F., Cap, A. P., Dubick, M. A., Morrison, J. J., Midwinter, M. J., Butler, F. K., Kotwal, R. S., & Holcomb, J. B. (2012). Military medical revolution. Journal of Trauma and Acute Care Surgery, 73(6), S372-S377. https://doi.org/10.1097/ta.0b013e3182755662

Department of Homeland Security. STOP the Bleed [Internet]. Washington, DC: DHS; 2016. https://www.dhs.gov/stopthebleed

Holcomb, J. B., Jenkins, D., Rhee, P., Johannigman, J., Mahoney, P., Mehta, S., Cox, E. D., Gehrke, M. J., Beilman, G. J., Schreiber, M., Flaherty, S. F., Grathwohl, K. W., Spinella, P. C., Perkins, J. G., Beekley, A. C., McMullin, N. R., Park, M. S., Gonzalez, E. A., Wade, C. E., … Hess, J. R. (2007). Damage control resuscitation: Directly addressing the early Coagulopathy of trauma. Journal of Trauma: Injury, Infection & Critical Care, 62(2), 307-310. https://doi.org/10.1097/ta.0b013e3180324124

Hughes, N. T., Burd, R. S., & Teach, S. J. (2014). Damage control resuscitation. Pediatric Emergency Care, 30(9), 651-656. https://doi.org/10.1097/pec.0000000000000217

Advanced trauma life support (ATLS®): The ninth edition. (2013). Journal of Trauma and Acute Care Surgery, 74(5), 1363-1366. https://doi.org/10.1097/01586154-201305000-00026

De Caen, A. R., Berg, M. D., Chameides, L., Gooden, C. K., Hickey, R. W., Scott, H. F., Sutton, R. M., Tijssen, J. A., Topjian, A., Van der Jagt, É. W., Schexnayder, S. M., & Samson, R. A. (2015). Part 12: Pediatric advanced life support. Circulation, 132(18_suppl_2). https://doi.org/10.1161/cir.0000000000000266

Samuels M, & Wieteska S. (2016). Structured approach to the seriously injured child. In: Advanced Paediatric Life Support. Chichester: John Wiley & Sons. 115–26. https://doi.org/10.1002/9781119241225.ch11

Edwards, M. J., Lustik, M. B., Clark, M. E., Creamer, K. M., & Tuggle, D. (2015). The effects of balanced blood component resuscitation and crystalloid administration in pediatric trauma patients requiring transfusion in Afghanistan and Iraq 2002 to 2012. Journal of Trauma and Acute Care Surgery, 78(2), 330-335. https://doi.org/10.1097/ta.0000000000000469

Acker, S. N., Ross, J. T., Partrick, D. A., DeWitt, P., & Bensard, D. D. (2014). Injured children are resistant to the adverse effects of early high volume crystalloid resuscitation. Journal of Pediatric Surgery, 49(12), 1852-1855. https://doi.org/10.1016/j.jpedsurg.2014.09.034

Tran, A., & Campbell, B. T. (2017). The art and science of pediatric damage control. Seminars in Pediatric Surgery, 26(1), 21-26. https://doi.org/10.1053/j.sempedsurg.2017.01.005

Skelton, T., & Beno, S. (2017). Massive transfusion in pediatric trauma. Journal of Trauma and Acute Care Surgery, 82(1), 211-215. https://doi.org/10.1097/ta.0000000000001294

Neff, L. P., Cannon, J. W., Morrison, J. J., Edwards, M. J., Spinella, P. C., & Borgman, M. A. (2015). Clearly defining pediatric massive transfusion: cutting through the fog and friction with combat data. Journal of Trauma and Acute Care Surgery, 78(1), 22-29. https://doi.org/10.1097/TA.0000000000000488

Dzik, W. H., Blajchman, M. A., Fergusson, D., Hameed, M., Henry, B., Kirkpatrick, A. W., Korogyi, T., Logsetty, S., Skeate, R. C., Stanworth, S., MacAdams, C., & Muirhead, B. (2011). Clinical review: Canadian national advisory committee on blood and blood products - Massive transfusion consensus conference 2011: report of the panel. Critical Care, 15(6), 242. https://doi.org/10.1186/cc10498

Borgman, M. A., Spinella, P. C., Perkins, J. G., Grathwohl, K. W., Repine, T., Beekley, A. C., Sebesta, J., Jenkins, D., Wade, C. E., & Holcomb, J. B. (2007). The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. Journal of Trauma: Injury, Infection & Critical Care, 63(4), 805-813. https://doi.org/10.1097/ta.0b013e3181271ba3

Holcomb, J. B., Del Junco, D. J., Fox, E. E., Wade, C. E., Cohen, M. J., Schreiber, M. A., Alarcon, L. H., Bai, Y., Brasel, K. J., Bulger, E. M., Cotton, B. A., Matijevic, N., Muskat, P., Myers, J. G., Phelan, H. A., White, C. E., Zhang, J., Rahbar, M. H., & PROMMTT Study Group, F. T. (2013). The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study. JAMA Surgery, 148(2), 127. https://doi.org/10.1001/2013.jamasurg.387

Paull, B. (2015). Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. The Journal of Emergency Medicine, 49(1), 122. https://doi.org/10.1016/j.jemermed.2015.05.025

Christiaans, S. C., Duhachek-Stapelman, A. L., Russell, R. T., Lisco, S. J., Kerby, J. D., & Pittet, J. (2014). Coagulopathy after severe pediatric trauma. Shock, 41(6), 476-490. https://doi.org/10.1097/shk.0000000000000151

Choi, P. M., & Vogel, A. M. (2014). Acute coagulopathy in pediatric trauma. Current Opinion in Pediatrics, 26(3), 343-349. https://doi.org/10.1097/mop.0000000000000086

Rossaint, R., Bouillon, B., Cerny, V., Coats, T. J., Duranteau, J., Fernández-Mondéjar, E., ... & Spahn, D. R. (2016). The European guideline on management of major bleeding and coagulopathy following trauma. Critical care, 20, 1-55. https://doi.org/10.1186/s13054-016-1265-x

Nosanov, L., Inaba, K., Okoye, O., Resnick, S., Upperman, J., Shulman, I., Rhee, P., & Demetriades, D. (2013). The impact of blood product ratios in massively transfused pediatric trauma patients. The American Journal of Surgery, 206(5), 655-660. https://doi.org/10.1016/j.amjsurg.2013.07.009

Hwu, R. S., Spinella, P. C., Keller, M. S., Baker, D., Wallendorf, M., & Leonard, J. C. (2016). The effect of massive transfusion protocol implementation on pediatric trauma care. Transfusion, 56(11), 2712-2719. https://doi.org/10.1111/trf.13781

Gonzalez, E. A., Moore, F. A., Holcomb, J. B., Miller, C. C., Kozar, R. A., Todd, S. R., Cocanour, C. S., Balldin, B. C., & McKinley, B. A. (2007). Fresh frozen plasma should be given earlier to patients requiring massive transfusion. The Journal of Trauma: Injury, Infection, and Critical Care, 62(1), 112-119. https://doi.org/10.1097/01.ta.0000250497.08101.8b