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Hemorrhagic shock in children is a life-threatening condition with a mortality rate as high as 36-50%.¹ Immediate infusion of blood products can help reverse the systemic effects of shock by restoring circulating blood volume and preventing multi-organ failure. However, since children are even more susceptible to the effects of blood loss and can rapidly progress to hemodynamic collapse, early recognition and treatment of hemorrhagic shock are essential.²

Difficulty with intravenous (IV) access and small-gauge IV catheters are additional challenges to effective resuscitation.³ Traditional infusion methods, including the push-pull technique, pressure bags, and traditional rapid infusers, fail to account for these challenges and often delay care.⁴

This case study highlights the role of LifeFlow PLUS in stabilizing a 5-year-old patient presenting with hemorrhagic shock caused by suspected GI bleeding.

Case Presentation

A 5-year-old female with a medical history of developmental delay presented to the Emergency Department via EMS following two episodes of hematemesis and bloody stools at home. On arrival, the patient was covered in blood, tachycardic with a heart rate of 180 bpm, hypotensive with a systolic blood pressure (SBP) of 60-70 mmHg, pale, and exhibiting delayed capillary refill (>5 seconds). Initial pulse oximetry was unobtainable but later read >90%, and her weight was noted as 18 kg.

The patient was lethargic, intermittently opened her eyes, and had minimal response to pain. Shortly after arrival, she began vomiting blood clots. Initial assessment confirmed hemorrhagic and hypovolemic shock, though the precise etiology of the bleeding remained unknown.

Management

Identifying the patient’s critical condition, rapid resuscitation was initiated with blood products and crystalloids using the LifeFlow and QinFlow Warrior warmer. The transfusion was initiated through two 22-gauge peripheral intravenous (PIV) catheters in the patient’s bilateral ACs.

Despite transient improvements in SBP to >80 mmHg following rapid boluses of blood and/or crystalloid fluids, the patient’s blood pressure continued to fluctuate, dropping back to 50-60 mmHg. Due to ongoing hemodynamic instability, the patient was intubated for airway protection using ketamine and rocuronium, and an epinephrine drip was started. Protonix was also administered given the suspicion of gastrointestinal bleeding.

Once intubated and sedated, the patient was transported to the endoscopy suite for further evaluation, but due to the presence of excessive blood, visualizing the source of the bleed was unsuccessful. The patient was subsequently admitted to the PICU for continued care.

From arrival at the trauma bay at 1500 through 1900, the patient received a total of:

• 160 mL/kg of crystalloid fluids
• 150 mL/kg of blood products (PRBCs and FFP) administered via LifeFlow and warmed with the QinFlow Warrior
• Several units of platelets and cryoprecipitate administered via an infusion pump

Despite ongoing resuscitation, the patient’s blood pressure continued to fluctuate between 50-90 mmHg. Overnight, her condition remained critical, with persistent nasogastric blood output, pallor, mottled skin, capillary refill of 5-8 seconds, and an elevated lactate level of 6. A norepinephrine drip was started alongside epinephrine and ongoing boluses to address her instability.

Massive transfusion protocol (MTP) was initiated, and the patient received an additional 100 mL/kg of crystalloids, 10 mL/kg of FFP, and 30 mL/kg of PRBCs.

The patient was then transferred to another facility where interventional radiology successfully identified and embolized an arterial abdominal bleed. Following this procedure, the patient showed significant clinical improvement, ultimately made a full recovery and was discharged home.

Discussion

This case underscores the critical role of rapid fluid and blood product administration in pediatric patients experiencing hemorrhagic shock.^2,5 Given the patient’s profound hemodynamic instability, traditional IV infusion methods may have been insufficient to restore adequate perfusion in a timely manner. The use of LifeFlow PLUS allowed for controlled, high-volume administration of blood and fluids through a warming device, facilitating more effective resuscitation and potentially preventing further decompensation.

Studies suggest that early, aggressive resuscitation with blood products in pediatric hemorrhagic shock improves survival rates, particularly when balanced transfusion strategies are employed.^2,5 Devices such as LifeFlow provide an efficient means of delivering critical fluids in time-sensitive scenarios, offering an advantage over traditional pressure bags and manual push-pull techniques.⁴

Furthermore, integrating the QinFlow warmer ensured the blood products and fluids were administered at physiologically appropriate temperatures, reducing the risk of hypothermia—a known complication of massive transfusion.⁶

The clinical team’s ability to identify the need for rapid resuscitation and employ innovative tools like LifeFlow PLUS and QinFlow contributed to this patient’s positive outcome. They noted LifeFlow’s ease-of-use and faster setup times compared to priming separate tubing for an IV pump.

A nurse involved with the case commented, “This user loves the LifeFlow! There is no faster method in our unit for infusing blood products or IV fluids. It is incredibly easy to use, even for a beginner.”