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Damage Control Resuscitation in a 12-Year Old Girl with Severe Thoraco-Abdominal Polytrauma

Mayr J, Bronnimann E, Studer D, Trachsel D, Holland Cunz-S and Hulliger S

Introduction: A 12-year old girl experienced severe polytrauma after falling from a height of 20 m (ISS: 48). The girl was transported by helicopter using a “scoop-andrun” strategy. Ringer`s solution (500 mL) and tranexamic acid (500 mg) were administered. Intravenous administration of crystalloid solution was minimized, and blood and blood products were administered.

Case report: The child was intubated in the emergency room, and the tension pneumothorax was drained. The following findings were recorded: Serum lactate: 10.0 mmol/L, Base excess: -13.4 mmol/L, pH: 6.96, Hb: 100 g/L, INR: 1.65, Core Temperature: 35.9°C. Respiration rate before Intubation: 40/min, Pulse rate: 140/min, Blood Pressure: 85/46 mmHg, Glasgow Coma Scale: 6. The CT scan revealed liver laceration, ruptured pancreatic tail, ruptured spleen, rupture of the right kidney, bilateral hemopneumothorax, a small subdural hematoma, intimal tear of the right carotid artery, central dislocation of the left hip joint, and a fracture of the humerus. Due to the presence of the “lethal triad” (acidosis, hypothermia, and coagulopathy), we used the damage control resuscitation (DCR) strategy, refraining from surgery within the first 24h. We induced permissive hypotension and stabilized the cardiopulmonary situation at the pediatric intensive care unit (PICU). After 24h, we reduced the dislocated hip fracture and stabilized the fracture of the humerus without reduction. Eight days later, the fractures were treated with open reduction and internal fixation. Hepatic bile duct injury was treated with stent insertion guided by endoscopic retrograde cholangiography (ERCG). The child survived, and only minor cerebral alterations were noted at follow-up.

Conclusion: DCR strategy offers a rewarding treatment option in children who sustained severe polytrauma. Broad application of this strategy in children necessitates further studies.