This activity is an Accredited Self-Assessment Program (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the Canadian Anesthesiologists' Society. You may claim a maximum of 1 hour (credits are automatically calculated). 

From the perspective of a community hospital, this problem-based learning discussion (PBLD) explores the modern approach to life-threatening hemorrhage in children, emphasizing early recognition and timely, coordinated management. Key topics include the epidemiology of pediatric massive hemorrhage; current definitions and limitations in activation criteria; and how size, anatomy, and physiology create unique vulnerabilities compared with adults. Discussion will review evidence for inequities in pediatric trauma and transfusion care and highlight the importance of efficient communication—particularly around critical laboratory values, patient location, and standardized handovers across teams and institutions. Participants will examine practical strategies for the administration of blood components, coagulation factor concentrates, and adjunct hemostatic agents, along with evidence-based transfusion targets and coagulation monitoring. The session introduces the “7Ts” pediatric massive hemorrhage protocol (MHP) framework – Trigger, Team, Tranexamic Acid, Temperature, Testing, Transfusion and Termination (or Transfer) – to integrate these concepts into a structured and reproducible approach. A comparison of fixed-ratio massive transfusion protocols (MTPs) and goal-directed MHPs will highlight their implications for optimal blood use (OBU) and patient management perspectives. Controversies including pediatric MHP activation thresholds and the evolving role of whole blood will be addressed. Participants will also review a practical pediatric handover tool adapted from the Ontario Regional Blood Coordinating Network (ORBCoN) MHP Toolkit. 

After participating in this PBLD, participants will be able to: 

1. Define massive hemorrhage in children. 

2. Discuss the implications of a child’s size, anatomy and physiology in relation to massive hemorrhage. 

3. List the "seven key components" of a pediatric MH protocol (MHP). 

Fee:
Members: $45
Non-Members: $75
 

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Facilitator: Dr. Kimmo Murto 
Anesthesiologist, Children's Hospital of Eastern Ontario Research Institute 

Dr. Kimmo Murto is a Tier 2 Clinical Research Chair in the Faculty of Medicine at the University of Ottawa, leading the program Child Health Innovative Research-Perioperative Care & Patient Blood Management (CHIRP2) for Kids. This dual-stream program focuses on perioperative adenotonsillectomy care and personalized patient blood management. His research interests include reducing acute/chronic postoperative pain, identifying high-performing hospitals based on patient postoperative healthcare-resource utilization, examining the role of obstructive sleep apnea and perioperative inflammation in patient outcomes, optimizing blood health, developing strategies for managing massive hemorrhage, strengthening pediatric hemovigilance, and leveraging technology to enhance value in healthcare service delivery. Dr. Murto serves on the scientific committees of both the Canadian Pediatric Anesthesia Society (CPAS) and the Society for the Advancement of Patient Blood Management (SABM). He is also a member of the American Society of Anesthesiologists (ASA) Patient Blood Management (PBM) and Pediatric Anesthesia Committees and the Society for Pediatric Anesthesia (SPA) PBM Special Interest Group.