High crystalloid volumes negate benefit of hemostatic resuscitation in pediatric wartime trauma casualties.

This DoD Trauma Registry study of 521 pediatric combat casualties found that high FFP:PRBC ratios improved survival only when crystalloid volumes were restricted below 40mL/kg. Excessive crystalloid administration negated the survival benefit of hemostatic resuscitation, particularly in younger children, highlighting the critical need to limit fluids during massive transfusion.