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[Management of massive bleeding in 2013: seven questions and answers]

A Godier1, C M Samama, S Susen

  • 1Service d'anesthésie-réanimation, université Paris Descartes, hôpital Cochin, groupe hospitalier Cochin-Hôtel-Dieu, 27, rue du Faubourg-St-Jacques, 75014 Paris, France.

Transfusion Clinique Et Biologique : Journal De La Societe Francaise De Transfusion Sanguine
|April 17, 2013
PubMed

The management of massive bleeding has improved, thanks to high-quality blood components and new transfusion strategies. However, it remains controversial and, despite a huge body of literature, randomised control trials are still lacking. However, the therapeutic approach has also evolved, requiring earlier and more active management. If a 'no delay' management is well recognized, its modes are still discussed. Immediate delivery of blood products with ratios close to 1:1:1 for RBC units/fresh frozen plasma/platelet concentrates, through massive transfusion protocol using blood packs, has been advocated, but yet this approach is not evidence-based. Secondly, a targeted strategy to provide fibrinogen concentrates is under evaluation. Tranexamic acid is effective in trauma patients. Recombinant factor VIIa should only be used on a compassionate basis.

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