Canadian tertiary care pediatric massive hemorrhage protocols
A survey and comprehensive national review
Canadian Journal of Anaesthesia
Submitted June 2024 by Dr Michael Tan
Bleeding, often because of unintentional injury, is a leading cause of death in children Massive haemorrhage protocols improve outcomes. Dedicated paediatric protocols are needed due to unique physiological needs of children.
This study surveyed Canadian university affiliated paediatric centres with a validated questionnaire They asked for information regarding paediatric massive haemorrhage protocols and activation data All 18 centres approached provided a response. 5 did not have a dedicated paediatric massive haemorrhage protocol.
There was huge variability in protocols with regards to activation criteria, and transport container contents. Trauma was the most common cause for activation (54%). There was suggestion of underutilisation in non-traumatic bleeding.
The researchers conclude that in Canada, there is a need for consensus definition of paediatric massive haemorrhage, a validated activation tool along with a centralised data collection system. In New Zealand, the Health Quality and Safety Commission has already created evidence-based care bundles to provide guidance for massive transfusion in a wide range of populations including paediatrics. Individual hospitals can then customise the care bundles to establish massive haemorrhage protocols suited to their institutions.
