Massive Hemorrhage Protocol

Time is life! Every one-minute delay in receiving the first pRBC is associated with a 5% increase in mortality - Saswata Deb & Priyank Bhatnagar

Massive Hemorrhage Protocol
Massive Hemorrhage Protocol

image by: Sajith Kumar Nursing Tutorials

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The 7 Ts of Massive Hemorrhage Protocols

Our experts recommend a 2:1:1 ratio of blood products based on their interpretation of the PROPPR trial which found that among patients with severe trauma and major bleeding there was no significant difference in 24hr or 30 day mortality in patients who received a 1:1:1 ratio compared to a 2:1:1 ratio, and because of practical considerations that allow faster administration of blood products using the 2:1:1 ratio.

The first case of blood products should contain 4 units uncrossmatched pRBCs, be at the bedside in under 10 minutes, and IV running via rapid transfuser shortly thereafter.

Then the next case of blood products contains 4 RBC and 4 plasma (FFP) which should run…

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Resources

 The 7 Ts of Massive Hemorrhage Protocols

The classic definition of massive transfusion protocol is 10 units of pRBC over 24 hours and only focuses on the number of blood products transfused. Instead, the emphasis should be placed on hemorrhage control which not only includes transfusions, but also monitoring blood work/considering targets, administration of other medications including tranexamic acid, keeping the patient warm and source control of the bleeding.

Life in the Fastlane

Hb: This should not be used alone as transfusion trigger; and, should be interpreted in context with haemodynamic status, organ & tissue perfusion.

Massive transfusion protocol template

This document, Patient Blood Management Guidelines: Module 1 – Critical Bleeding/Massive Transfusion, is the first in a series of six modules that focus on evidence-based patient blood management.

Rush Emergency Medicine

The goal of MTP is to rapidly provide blood products while also preventing the “lethal triad” of acidosis, hypothermia, and coagulopathy that prolongs hemorrhage.

WikEM

The PROPPR trial[5] examined a 1:1:1 (FFP:Plt:pRBC) vs 1:1:2 protocol. There was no difference in mortality at 1 or 30 days; however, the 1:1:1 group experienced less death due to exsanguination in the first day.

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