Prehospital blood administration in pediatric trauma patients is crucial due to its potential to improve outcomes by addressing hemorrhagic shock early in the care continuum. While prehospital blood transfusion in pediatric trauma cases is not yet a common practice, studies have highlighted the benefits it can offer. Early administration of blood products in severe trauma cases has been associated with improved patient outcomes, particularly in cases with a high risk of massive hemorrhage (Wang et al., 2016). Pediatric trauma patients requiring early blood transfusion often present with lower blood pressures, higher heart rates, higher shock indices, and lower pulse pressures, emphasizing the need for prompt intervention (Zhu et al., 2021). Furthermore, prehospital whole blood transfusion has been shown to reduce early mortality in trauma patients with hemorrhagic shock, indicating the life-saving potential of this intervention (Braverman et al., 2021).
Although the logistics of prehospital transfusion can be challenging, it is essential for pediatric trauma centers to collaborate with blood banks, emergency medical services, and trauma facilities to facilitate timely and effective blood product administration (Russell & Koenig, 2023). The use of prehospital blood transfusion should help prevent trauma-induced coagulopathy and enhance oxygen delivery capacity, potentially mitigating the adverse effects of severe injuries in pediatric patients (Alomar-Dominguez, 2024). Additionally, the shift towards balanced prehospital blood product transfusions in treating hemorrhaging trauma patients underscores the evolving approach towards early blood product administration in prehospital settings (Yliharju et al., 2022).
In conclusion, while prehospital blood administration in pediatric trauma patients may currently face challenges and limited adoption, the evidence suggests that it holds significant promise in improving outcomes by addressing hemorrhagic shock early on. Collaborative efforts among healthcare providers, trauma centers, and emergency services are essential to streamline the process and ensure timely and effective prehospital blood transfusions for pediatric trauma cases.
References:
- Alomar-Dominguez, C. (2024). Prehospital transfusion of allogeneic blood products. Current Opinion in Anaesthesiology, 37(2), 144-147.
https://doi.org/10.1097/aco.0000000000001353
- Braverman, M., Smith, A., Pokorný, D., Axtman, B., Shahan, C., Barry, L., … & Jenkins, D. (2021). Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion, 61(S1).
https://doi.org/10.1111/trf.16528
- Russell, R. and Koenig, S. (2023). Prehospital transfusion in pediatric trauma—the clock is ticking. Jama Pediatrics, 177(7), 663.
https://doi.org/10.1001/jamapediatrics.2023.1297
- Wang, H., Umejiego, J., Robinson, R., Schrader, C., Leuck, J., Barra, M., … & Zenarosa, N. (2016). A derivation and validation study of an early blood transfusion needs score for severe trauma patients. Journal of Clinical Medicine Research, 8(8), 591-597.
https://doi.org/10.14740/jocmr2598w
- Yliharju, H., Jama, T., & Nordquist, H. (2022). Initial experiences of prehospital blood product transfusions between 2016 and 2020 in päijät-häme hospital district, finland. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 30(1).
https://doi.org/10.1186/s13049-022-01027-z
- Zhu, C., Braverman, M., Goddard, S., McGinity, A., Pokorný, D., Cotner-Pouncy, T., … & Jenkins, D. (2021). Prehospital shock index and systolic blood pressure are highly specific for pediatric massive transfusion. Journal of Trauma and Acute Care Surgery, 91(4), 579-583.
https://doi.org/10.1097/ta.0000000000003275