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hemostatic resuscitation in pediatric patient

Ioannis N Liras, Bryan A Cotton, Jessica C Cardenas, Matthew T Harting
INTRODUCTION: Hyperfibrinolysis (HF) on admission is associated with increased mortality in adult patients with trauma. Several studies have demonstrated that 9% of severely injured adults present to the emergency department (ED) with HF. Our aim was to (1) define HF in pediatric patients and develop a relevant cut-point for therapeutic intervention (if any); (2) identify the prevalence of HF in severely injured pediatric patients; and (3) determine whether HF on admission is as lethal a phenomenon as it is in adults...
September 2015: Surgery
Naomi T Hughes, Randall S Burd, Stephen J Teach
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...
September 2014: Pediatric Emergency Care
Adam M Vogel, Zayde A Radwan, Charles S Cox, Bryan A Cotton
PURPOSE: Admission rapid thrombelastography (rTEG) is a "real-time" clinical tool used to evaluate trauma-induced coagulopathy and direct hemostatic resuscitation. The relationship of rTEG to conventional coagulation tests (CCT) and early lifesaving interventions (LSI) in pediatric trauma is unknown. METHODS: Severely injured patients (age ≤ 14 years) with an rTEG were retrospectively reviewed (8/1/2009-8/31/2011). Demographic and clinical information was collected...
June 2013: Journal of Pediatric Surgery
Scott J Luhmann, Daniel J Sucato, Leonard Bacharier, Alysa Ellis, Cyndi Woerz
BACKGROUND: FloSeal and SurgiFlo Hemostatic Matrices are commonly used in surgical procedures to promote coagulation and minimize blood loss. They are composed of bovine and porcine gelatin matrix, respectively, that can be injected into pedicles to stop osseous bleeding during pedicle screw insertion. METHODS: This report details 2 pediatric spinal deformity reconstructive surgery patients who experienced intraoperative cardiovascular events after the intraosseous administration of animal-derived gelatin...
July 2013: Journal of Pediatric Orthopedics
Alex M Dressler, Christine M Finck, Christopher L Carroll, Craig C Bonanni, Philip C Spinella
Use of a defined massive transfusion (MT) protocol for severe intraoperative bleeding in a pediatric patient has never been described. Herein we present a case whereby use of hemostatic resuscitation delineated in an MT protocol optimally treated hemorrhage resulting from a large tumor during right hepatectomy. The MT protocol principles, benefits, and postoperative course of the patient are described.
July 2010: Journal of Pediatric Surgery
Cade M Nylund, Matthew A Borgman, John B Holcomb, Donald Jenkins, Philip C Spinella
OBJECTIVE: To describe the use of thromboelastography (TEG) to direct hemostatic resuscitation in a child with traumatic injury requiring massive transfusion. DESIGN: Case report. SETTING: Level 1 pediatric trauma center in an academic tertiary care facility. PATIENT: A 5-year-old boy with grade IV liver injury and right common hepatic artery laceration. INTERVENTION: TEG-directed resuscitation, including recombinant activated factor VII...
March 2009: Pediatric Critical Care Medicine
M Mekki, A Nouri, M Belghith, I Krichene, A Gargouri, H Sboui, M T Sfar
PATIENTS AND RESULTS: A series of four cases observed in the department of pediatric surgery in Monastir between 1990 and 1998 are reported. The diagnosis was made in the two first days of life. The clinical features associated paleness, shock and abdominal distension. Ultrasonography revealed that the hemoperitoneum was associated with liver hematoma in three cases and with retroperitoneal hematoma in two cases. Three infants required emergency hemostatic laparotomy. The fourth was stabilized by initial resuscitation...
April 2000: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
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