Whole Blood Resuscitation for Pediatric Trauma: Why We Must Move Forward

• Published in: Current surgery reports (Philadelphia, PA) PA), 2021-04, Vol.9 (4), Article 9
• Main Authors: Mar, Pamela, Edwards, Mary J.
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Pediatric Surgery; Pediatric Surgery (A. Fischer; Section Editor; Surgery
• ISSN: 2167-4817; 2167-4817
• DOI: 10.1007/s40137-021-00287-5

Purpose of Review To outline the current state of whole blood transfusion in pediatric trauma. To discuss the potential risks and benefits of this product for the child in hemorrhagic shock. Recent Findings Whole blood has significant benefits when compared to balanced component transfusions for hemorrhage. In adults, limited studies investigating the use of type O low-titer whole blood have found it to be safe, and with equivalent clinical and laboratory outcomes when compared to balanced component strategies. Such studies have lacked the power to demonstrate superiority. In children, the experience in trauma is exceedingly limited, but initial studies have not demonstrated any safety concerns. Utilization of un-crossmatched whole blood in children is theoretically more prone to hemolytic reactions given their small blood volume. Summary The potential benefits of whole blood for the hemorrhaging child are tremendous and would address many of the logistical and safety concerns inherent in component-based resuscitation strategies. The concerns regarding ABO incompatibility can likely be addressed with low-titer products and immediate investigation is critical to allow more widespread utilization of whole blood in pediatric trauma.