Facing futility in hemorrhagic shock: when to say ‘when’ in children and adults
The last two decades have seen increased efforts at early identification of those likely to require life-saving interventions such as rapid response teams, massive transfusion delivery, extracorporeal membrane oxygenation, and emergent surgical procedures.1–3 However, it was not until recently that this same level of interest was directed at limiting early interventions in severely injured patients where such efforts might be futile. Not surprisingly, it was the COVID-19 pandemic and its disruption of vital supply chains that brought this to the forefront. During the early months of the COVID-19 pandemic, a 50% reduction in blood donations was offset by a significant drop in demand for products due to restrictions on elective surgery.4 However, as society and its institutions began reopening, with surgical schedules returning to ‘normal’ and trauma volumes rebounding, the supply of blood required was unable to keep up. Adding to this was an increase in trauma, particularly penetrating