Massive Transfusion Protocols in Pediatric Trauma

Purpose of Review: This review summarizes the literature that has guided the development of modern-day massive transfusion protocols in children with life-threatening traumatic injury. Recent Findings: Limited pediatric-specific research has been published to suggest ideal hemostatic resuscitation practice in children. Initial data suggests whole blood or balanced component therapy, antifibrinolytics, and cryoprecipitate are independently associated with improved outcomes. The use of viscoelastic hemostatic assays for goal-directed hemostatic resuscitation appears promising, but data is lacking to support its use to improve outcomes. Summary: Pediatric massive transfusion protocols are an ongoing area of research. Initial data suggests that a massive transfusion protocol for children with life-threatening traumatic hemorrhage should consider including whole blood, antifibrinolytics, and cryoprecipitate. Definitive clinical trials are needed to establish optimal massive transfusion protocols in children with severe bleeding due to traumatic injury to improve outcomes.