A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation
Until the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in s...
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Elsevier
2025-03-01
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| Series: | Brazilian Journal of Anesthesiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001424001052 |
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| author | David Silveira Marinho Denise Menezes Brunetta Luciana Maria de Barros Carlos Luany Elvira Mesquita Carvalho Jessica Silva Miranda |
| author_facet | David Silveira Marinho Denise Menezes Brunetta Luciana Maria de Barros Carlos Luany Elvira Mesquita Carvalho Jessica Silva Miranda |
| author_sort | David Silveira Marinho |
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| description | Until the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called “Damage Control Resuscitation”. This strategy includes four principles: damage control surgery, minimization of crystalloids, permissive hypotension and hemostatic resuscitation. The latter involves the use of antifibrinolytics, correction of preconditions of hemostasis (calcium, pH and temperature) and the early and rapid restoration of intravascular volume with blood products. To enable timely availability and transfusion of blood products, specific actions in different hospital areas need to be synchronized, which are usually organized through Massive Transfusion Protocols or, as they have recently been rebranded, Major Hemorrhage Protocols (MHPs). Although these bundles of actions represent a paradigm change, essential aspects such as their historical evolution, theoretical foundations, terminology and operational elements have yet to be well explored. Considering the wide application range of these tools (emergency departments, interventional radiology, operating rooms and military fields), it is essential to integrate all professionals involved with severe hemorrhage scenarios in the implementation of the aforementioned protocols, from conception to execution and management. This review paper addresses MHP aspects relevant to anesthesiologists, transfusion services and other areas involved with the care of patients with severe bleeding. |
| format | Article |
| id | doaj-art-ca4b38442fd345b69fda3158146f48b3 |
| institution | Kabale University |
| issn | 0104-0014 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | Brazilian Journal of Anesthesiology |
| spelling | doaj-art-ca4b38442fd345b69fda3158146f48b32025-01-28T04:14:23ZengElsevierBrazilian Journal of Anesthesiology0104-00142025-03-01752844583A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementationDavid Silveira Marinho0Denise Menezes Brunetta1Luciana Maria de Barros Carlos2Luany Elvira Mesquita Carvalho3Jessica Silva Miranda4Serviço de Anestesiologia, Instituto Doutor José Frota; Unidade de Transplante Hepático, Serviço de Anestesiologia, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil; Corresponding author.Centro de Hematologia e Hemoterapia do Ceará (HEMOCE); Empresa Brasileira de Serviços Hospitalares (EBSERH); Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, BrazilCentro de Hematologia e Hemoterapia do Ceará (HEMOCE); Núcleo Transfusional, Instituto Doutor José Frota, Fortaleza, CE, BrazilCentro de Hematologia e Hemoterapia do Ceará (HEMOCE); Empresa Brasileira de Serviços Hospitalares (EBSERH); Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, BrazilDivision of Cardiothoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Hospital; Assistant Professor, Mount Sinai School of Medicine, New York, NY, USAUntil the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called “Damage Control Resuscitation”. This strategy includes four principles: damage control surgery, minimization of crystalloids, permissive hypotension and hemostatic resuscitation. The latter involves the use of antifibrinolytics, correction of preconditions of hemostasis (calcium, pH and temperature) and the early and rapid restoration of intravascular volume with blood products. To enable timely availability and transfusion of blood products, specific actions in different hospital areas need to be synchronized, which are usually organized through Massive Transfusion Protocols or, as they have recently been rebranded, Major Hemorrhage Protocols (MHPs). Although these bundles of actions represent a paradigm change, essential aspects such as their historical evolution, theoretical foundations, terminology and operational elements have yet to be well explored. Considering the wide application range of these tools (emergency departments, interventional radiology, operating rooms and military fields), it is essential to integrate all professionals involved with severe hemorrhage scenarios in the implementation of the aforementioned protocols, from conception to execution and management. This review paper addresses MHP aspects relevant to anesthesiologists, transfusion services and other areas involved with the care of patients with severe bleeding.http://www.sciencedirect.com/science/article/pii/S0104001424001052Blood component transfusionBlood coagulation disordersExsanguinationHemostasisHemorrhageShock, hemorrhagic |
| spellingShingle | David Silveira Marinho Denise Menezes Brunetta Luciana Maria de Barros Carlos Luany Elvira Mesquita Carvalho Jessica Silva Miranda A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation Brazilian Journal of Anesthesiology Blood component transfusion Blood coagulation disorders Exsanguination Hemostasis Hemorrhage Shock, hemorrhagic |
| title | A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation |
| title_full | A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation |
| title_fullStr | A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation |
| title_full_unstemmed | A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation |
| title_short | A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation |
| title_sort | comprehensive review of massive transfusion and major hemorrhage protocols origins core principles and practical implementation |
| topic | Blood component transfusion Blood coagulation disorders Exsanguination Hemostasis Hemorrhage Shock, hemorrhagic |
| url | http://www.sciencedirect.com/science/article/pii/S0104001424001052 |
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