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Related Experiment Video

Updated: Aug 29, 2025

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Published on: October 15, 2021

Major haemorrhage: past, present and future.

A Shah¹, V Kerner², S J Stanworth³

¹Nuffield Department of Clinical Neurosciences, University of Oxford, UK.

|September 12, 2022

Summary

Major haemorrhage management has evolved to a

Keywords:

crystalloid resuscitation: coagulopathy major haemorrhage transfusion trauma

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Area of Science:

Emergency Medicine
Critical Care
Trauma Surgery

Background:

Major haemorrhage is a significant global cause of death.
Effective management involves early recognition, resource availability, and rapid intervention.
Haemorrhage often leads to volume loss, haemodilution, acidaemia, hypothermia, and coagulopathy.

Purpose of the Study:

To review the current evidence-based management of major haemorrhage.
To highlight the evolving strategies in haemostatic resuscitation.
To discuss the role of specific interventions like fresh frozen plasma and tranexamic acid.

Main Methods:

Review of current literature and recent trial data.
Analysis of evolving management protocols for major haemorrhage.
Emphasis on a personalized, scenario-dependent approach to resuscitation.

Main Results:

Haemostatic resuscitation now includes bleeding control, haemostasis monitoring, critical care, and avoiding the lethal triad.
Early administration of fresh frozen plasma (1:1 ratio with red blood cells) is recommended in major trauma.
Tranexamic acid is beneficial in trauma and postpartum haemorrhage but contraindicated in GI bleeding.
Maintaining adequate fibrinogen levels is crucial (> 2 g/L in PPH, > 1.5 g/L otherwise).

Conclusions:

Management strategies are shifting towards personalized, evidence-based haemostatic resuscitation.
Prehospital blood-product resuscitation is an area of active research to improve outcomes.
Optimizing the management of major haemorrhage remains critical for reducing mortality and morbidity.