Development of a massive transfusion protocol

Massive transfusion is a consequence of uncontrolled bleeding. It taxes the resources of both hospital and physicians. It occurs most commonly in trauma, cardiac and vascular surgery and less frequently in obstetrics. There are well established principles in dealing with massive transfusion. There is predictability in the "lethal" triangle of acidosis, hypothermia and coagulopathy. The protocol addresses these issues with logical recommendations. It addresses the use of factor VIIa as an adjunct. The protocol was developed with the input from transfusion medicine, trauma surgery, emergency and ICU and anaesthesia. The protocol is distributed with the 7th unit of blood issued and is a reminder of the principles. Results are tracked and may lead to modifications in the protocol.