Current Concepts in Pediatric Critical Care-4: Massive Bleeding

Video Transcription

Video Summary

In this presentation on massive bleeding in critically ill children, the speaker discusses the difference between life-threatening bleeding and massive bleeding. They explain that while life-threatening bleeding can include both massive bleeding and smaller amounts of bleeding in enclosed compartments, it's crucial to distinguish between the two. The speaker then goes on to discuss the categorization of massive bleeding and the definition of massive transfusion in adults and children. They highlight the limitations of the data on massive transfusion and emphasize the need for further research in different patient populations. Next, the speaker presents the results of a survey on massive transfusion protocol activation, which shows that physician discretion is the most common indication for activation. They also discuss a recent study on epidemiology, practice patterns, and outcomes in children with life-threatening bleeding, which reveals a high incidence of morbidities and a 28-day mortality rate of 37.5%. The speaker then explores the mechanisms associated with massive bleeding, including the primary coagulopathy and endotheliopathy known as blood failure. They discuss the concept of hemostatic resuscitation and the importance of balanced transfusion in improving outcomes. The speaker also highlights the potential benefits of low-titer group O whole blood compared to individual components. Additionally, they discuss the use of antifibrinolytics such as tranexamic acid and their association with improved survival. The presentation concludes with a discussion on intravenous hemostatic adjuncts and the need for further research on monitoring hemostatic treatment. Overall, the speaker emphasizes the need for better definitions and protocols in the management of massive bleeding in critically ill children.

Asset Caption

Philip Spinella, MD, FCCM

Keywords

massive bleeding

life-threatening bleeding

massive transfusion

hemostatic resuscitation

tranexamic acid

blood failure

critically ill children

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