Click to goto CDHA Public Site Click to goto DivEMS Dal Public Site Click to goto EHS Nova Scotia
Hypovolemic Shock

Date Last Search Run: Mar 03, 2025
Table last updated: Jan 28, 2025
Data last added: Dec 19, 2024

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)  
2 (fair evidence exists)  
3 (weak evidence exists)      


Interventions

Aggressive Crystalloids
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) 30 day in-hospital mortality Patient Garwe T., Johnson JJ., Letton RW. Indication bias explains some of the observed increased mortality associated with use of prehospital intravenous fluids in a pediatric trauma population. Acad Emerg Med 2016; 23(1):83-92. Medline

Blood transfusion
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) 24 hour mortality Patient PH-Paramedic & CCT Morgan KM, Abou-Khalil E, Strotmeyer S, Richardson WM, Gaines BA, Leeper CM. Association of Prehospital Transfusion With Mortality in Pediatric Trauma. JAMA Pediatr 2023 Medline
III Supportive (Green) Safety (transfusion reaction/TRALI/Fever/Sepsis/Volume overload) Patient PH-Paramedic & CCT Fahy AS, Thiels CA, Polites SF, Parker M, Ishitani MB, Moir CR, et al. Prehospital blood transfusions in pediatric trauma and nontrauma patients: a single-center review of safety and outcomes. Pediatr Surg Int 2017; 33(7):787-92. Medline
III Supportive (Green) 24 hour survival. Patient PH-Paramedic & CCT Moors XRJ, Bouman SJM, Peters JH, Smulders P, Oude Alink MB, Hartog DD, Stolker RJ. Prehospital Blood Transfusions in Pediatric Patients by a Helicopter Emergency Medical Service. Air Medical Journal 2018; 37(5): 321-4. Medline
III Supportive (Green) Hemodynamic status Patient PH-Paramedic Saab MA, Jacobson E, Hanson K, Kruciak B, Miramontes D, Harper S. Prehospital whole blood administration for pediatric gastrointestinal hemorrhage: A case report. Prehosp Emerg Care June 2024; 1-6. Medline

Colloid Infusion
Level Direction Primary Outcome Patient/Process Setting Reference

Dopamine
Level Direction Primary Outcome Patient/Process Setting Reference

Fluid Resuscitation
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Feasibility Patient ED-MD Stoner MJ., Goodman DG., Cohen DM., Fernandez SA., Hall MW. Rapid Fluid Resus in Peds: Testing the American College of Critical Care Medicine Guideline. Ann Emerg Med 2007; 50:601-7. Medline

Manual Intraosseous Insertion
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Survival to hospital discharge Patient Sunde G., Heradstveit B., Vikenes B., HeltneJ. Emergency intraosseous access in a helicopter emergency medical service: a retrospective study. Scan J Trauma, Resus and Emerg Med 2010; 18:52. Medline
III Supportive (Green) Success Patient ED-MD Voigt J., Waltzman M., Lottenberg L. Intraosseous vascular access for in-hospital emergency use: A systematic clinical review of the literature and analysis. Pediatr Emerg Care 2012; 28(2):185-199. Medline

Mechanical Intraosseous Insertion
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) First attempt success Patient Sunde G., Heradstveit B., Vikenes B., HeltneJ. Emergency intraosseous access in a helicopter emergency medical service: a retrospective study. Scan J Trauma, Resus and Emerg Med 2010; 18:52. Medline
II Neutral (Yellow) Placement success Process ED-MD Banerjee S., Singhi SC., Singh S., Singh S. The IO route is a suitable alternative to IV route for fluid resuscitation in severely dehydrated children. Ind Ped 1994; 31(12):1513-20. Medline
III Supportive (Green) Overall placement success Process PH-Paramedic Schalk R., Schweigkofler U., Lotz G., Zacharowski K., Latasch L., Byhahn C. Efficacy of the EZ-IO needle driver for out-of-hospital intraosseous access--a preliminary, observational, multicenter study. Scand J Trauma Resusc Emerg Med 2011; 19:65-7241-19-65. Medline
III Supportive (Green) Success Patient ED-MD Voigt J., Waltzman M., Lottenberg L. Intraosseous vascular access for in-hospital emergency use: A systematic clinical review of the literature and analysis. Pediatr Emerg Care 2012; 28(2):185-199. Medline

Norepinephrine
Level Direction Primary Outcome Patient/Process Setting Reference

Restricted Crystalloids
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) 30 day in-hospital mortality Patient Garwe T., Johnson JJ., Letton RW. Indication bias explains some of the observed increased mortality associated with use of prehospital intravenous fluids in a pediatric trauma population. Acad Emerg Med 2016; 23(1):83-92. Medline

Shock Prediction Tool
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Need for blood transfusion, operation, or intubation Patient Acker SN., Bredbeck B., Partrick DA., Kulungowski AM., Barnett CC., Bensard DD. Shock index, pediatric age-adjusted (SIPA) is more accurate than age-adjusted hypotension for trauma team activation. Surgery 2017; 161(3):803-7. Medline
II Supportive (Green) Factors and vital signs associated with massive transfusion Patient PH-Paramedic & CCT CS Z, Braverman M, Goddard S, McGinity AC, Pokorny D, Cotner-Pouncy T, et al. Prehospital shock index and systolic blood pressure are highly specific for pediatric massive transfusion. J Trauma Acute Care Surg 2021; 91(4):579–83. Medline
II Supportive (Green) Need for blood transfusion Process ED-MD Linnaus ME., Notrica DM., Langlais CS., et al. Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study. J Pediatr Surg. 2017;52(2):340-344. Medline
II Supportive (Green) Predictive value Process ED-MD Phillips R, Shahi N, Acker SN, Meier M, Shirek G, Stevens J, Recicar J, Moulton S, Bensard D. Not as simple as ABC: Tools to trigger massive transfusion in pediatric trauma. J Trauma Acute Care Surg 2022; 92(2):422–7. Medline
II Supportive (Green) Determine Shock index pediatric age-adjusted threshold value to predict mortality and / or massive transfusion Patient ED-Paramedic & MD Stevens J, Reppucci ML, Meier M, Phillips R, Shahi N, Shirek G, et al. Pre-hospital and emergency department shock index pediatric age-adjusted (SIPA) “cut points” to identify pediatric trauma patients at risk for massive transfusion and/or mortality. J Pediatr Surg 2021. Medline
II Neutral (Yellow) SI and SIPA are simple predictive tools with sufficient accuracy to be used in the prehospital environment Process Other Yoon SH, Shin SJ, Kim H, Roh YH. Shock index and shock index, pediatric age-adjusted as predictors of mortality in pediatric patients with trauma: A systematic review and meta-analysis. PLoS One. July 2024; 19(7):e0307367. Medline

Tranexamic Acid
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Mortality Patient Other Eckert MJ, Wertin TM, Tyner SD, Nelson DW, Izenberg S, Martin MJ. Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX). J Trauma Acute Care Surg. 2014 Dec;77(6):852-8; discussion 858. doi: 10.1097/TA.0000000000000443. PMID: 25423534. Medline
II Supportive (Green) In-hospital mortality Patient Other Hamele M, Aden JK, Borgman MA. Tranexamic acid in pediatric combat trauma requiring massive transfusions and mortality. J Trauma Acute Care Surg. 2020 Aug;89(2S Suppl 2):S242-S245. doi: 10.1097/TA.0000000000002701. PMID: 32265388. Medline
II Neutral (Yellow) Trauma mortality Patient PH-Paramedic Gendler S, Gelikas S, Talmy T, et al. Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry. Pediatr Crit Care Med 2023. Medline
II Neutral (Yellow) Use Process PH-MD & CCT Gossiome A, Claustre C, Fraticelli L, Jacquet L, Bouchut JC, Javouhey E, et al. Prehospital Tranexamic Acid in Major Pediatric Trauma Within a Physician-Led Emergency Medical Services System: A Multicenter Retrospective Study. Pediatr Crit Care Med 2022. Medline
II Neutral (Yellow) Adverse effects Patient PH-Paramedic Maeda T, Michihata N, Sasabuchi Y, Matsui H, Ohnishi Y, Miyata S, Yasunaga H. Safety of Tranexamic Acid During Pediatric Trauma: A Nationwide Database Study. Pediatr Crit Care Med. 2018 Dec;19(12):e637-e642. doi: 10.1097/PCC.0000000000001724. PMID: 30199511. Medline
II Neutral (Yellow) Survival to discharge Patient ED-MD Thomson JM, Huynh HH, Drone HM, Jantzer JL, Tsai AK, Jancik JT. Experience in an Urban Level 1 Trauma Center With Tranexamic Acid in Pediatric Trauma: A Retrospective Chart Review. J Intensive Care Med. 2021 Apr;36(4):413-418. doi: 10.1177/0885066619890834. Epub 2020 Feb 24. PMID: 32090705. Medline


[ PEP Database - Table of Contents ] [ Email: PEP@Dal.ca ]