The effects of balanced blood component resuscitation and crystalloid administration in pediatric trauma patients requiring transfusion in Afghanistan and Iraq 2002 to 2012

Abstract

Prognostic study, level IV.

Optimizing Transfusion Ratios in Massive Transfusion Protocols: An Argument Against the 1:1:1 Dogma and Approach to Trauma Resuscitation

“…Furthermore, analysis of data in pediatric trauma patients undergoing massive transfusions using a 1:1 ratio did not show a benefit from resuscitation using this ratio. 29 In fact, "when all transfused patients were considered, mortality was actually higher with this approach." 29 Although the findings of this study may not be generalizable to adults, its conclusions should be further investigated in this group.…”

Damage control resuscitation in children

“…In contrast, we have only insufficient evidence on efficacy of P-MTP although many authors had tried to prove it (Table 3) 17,[37][38][39][40][41][42][43][44] . The lack of proven survival benefit might be associated with low achievement rates of a 1:1 FFP:PRBC ratio (25%-37%) 17,39,43,44) and high TBI rates (30%-71%) 17,37,[39][40][41]43,44) (Table 3). Also, it might stem from the inherent difficulties of study on critically injured children, such as the low incidence of events and ethical problems in obtaining informed consent.…”

“…This study shows the association between large volume of crystalloids and increased length of stays at the intensive care units. In addition, large volume of crystalloids in the first 24 hours was associated with a higher mortality (18% [> 150 mL/kg] vs. 10% [≤ 150 mL/kg], P = 0.011) 17) . This evidence against excessive fluids is consistent with the deleted description of 3 crystalloid boluses in the tenth edition of the Advanced Trauma Life Support (Table 2) 18,19) .…”

In silico model of the dilutional effects of conventional component therapy versus whole blood in the management of massively bleeding adult trauma patients

“…1 However, the acidic nature of "normal" saline had not been appreciated and the potentially beneficial effect of permissive hypotension was not widely practiced. [2][3][4] More recently, an increasing body of evidence has demonstrated that aggressive resuscitation with crystalloid fluids might actually be detrimental to trauma patients, [5][6][7][8][9][10][11][12] and so modern trauma resuscitation protocols minimize their use.…”