Massive transfusion - simplified

 

Indications for MTP:

By volume

·      50% BV in 4h

·      100% BV in 24h

·      >150mL/min

By scenario

·      Anticipate bleeding +++

·      Thorax, abdo, long bone trauma

·      Obstetric bleeding +++

·      GI bleeding +++

 

Goals:

1.Haemostasis

a. Surgery:

·      Temporising: tourniquets, packs, binders

·      Definitive: not my job

b. Coagulation:

·      Reversal: e.g. protamine

·      Substrate: FFP, platelets, cryo

·      Adjuncts: TXA, Ca2+

·      Heat: air warmer + fluid warmer

c. Permissive hypotension:

·      mAP 50 until surgical control

 

Targets: plt >50, INR <1.5, fib >1, T >35, iCa >1.1

Use viscoelastic if available

2.Resuscitation

a. Anaesthesia:

·      Air goes in and out

·      Blood goes round and round

·      Unconscious and immobile

b. Vascular access:

·      2 x IVC + pump set + rapid warmer

·      A-line

·      CVC later

c. Transfusion:

·      CSL 2L max

·      O-neg if urgent

·      Crossmatched if time

·      Cell salvage if available

·      1:1:1 ratio

 

Targets: Hb >80, PaO2 >100, pH >7.2, lactate <4

 

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