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: Feb 01, 2022
Table last updated: May 29, 2022
Data last added: Sep 29, 2022

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
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

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) 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
X Not Yet Graded (White) - 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

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) 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
X Not Yet Graded (White) - 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 ]