Massive transfusion: An update for the anesthesiologist

Abstract

Exsanguination from trauma, gastrointestinal bleeding, and obstetric hemorrhage remains a major source of mortality across the planet. Continued research into resuscitation strategies and evolving technology and blood product storage has allowed for patient to undergo very large volume transfusions, even to the point of replacing a patient’s blood volume several times over. As massive transfusions have become more common, more studies have been performed delineating the exact patient population that would benefit, start- and stop-points of transfusions, complications and avoidance of the same. We discuss these points and provide information and strategies for massive transfusion.

Keywords: Massive transfusion protocol; Exsanguinating blood loss; Blood transfusion; Trauma surgery

Core tip: Recognizing the patient who requires massive transfusion early is key to the most optimal outcome. Once recognized, massive transfusion protocols (MTP) should be initiated and continued until normal physiologic parameters are reached and definitive control of bleeding is achieved. Hospitals should develop their own MTP, guided by the literature, and according to their specific needs and patient populations.