Massive hemorrhage update: what is known and what we should know?
Abstract
Massive hemorrhage protocol (MHP) is an updated term for the formerly used massive transfusion protocol, highlighting crucial aspects of hemorrhage management other than the transfusion itself. This complex intervention includes acute hemorrhage control; administering tranexamic acid (TXA), preventing hypocalcemia, hypothermia, and acidosis; reversing anticoagulation or correcting coagulopathies; and planning for the next steps in definitive hemorrhage control. Here, we discuss exciting frontiers and challenges of MHP.
1. Petrosoniak A, Li W, Hicks C. Just the facts: massive hemorrhage protocol. Canadian Journal of Emergency Medicine. 2023;25(2):115-7.
2. Callum JL, Yeh CH, Petrosoniak A, McVey MJ, Cope S, Thompson T, et al. A regional massive hemorrhage protocol developed through a modified Delphi technique. CMAJ Open. 2019;7(3):E546-E61.
3. Schroll R, Swift D, Tatum D, Couch S, Heaney JB, Llado-Farrulla M, et al. Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients. Injury. 2018;49(1):15-9.
4. Strickland M, Nguyen A, Wu S, Suen SC, Mu Y, Del Rio Cuervo J, et al. Assessment of machine learning methods to predict massive blood transfusion in trauma. World J Surg. 2023;47(10):2340-6.
5. Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: a practice management guideline from the Eastern association for the surgery of trauma. Journal of Trauma and Acute Care Surgery. 2017;82(3):605-17.
6. Meizoso JP, Cotton BA, Lawless RA, Kodadek LM, Lynde JM, Russell N, et al. Whole blood resuscitation for injured patients requiring transfusion: a systematic review, meta-analysis, and practice management guideline from the Eastern association for the surgery of trauma. J Trauma Acute Care Surg. 2024;97(3):460-70.
7. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471-82.
8. Ovesen C, Purrucker J, Grundtvig J, Mikkelsen TB, Gluud C, Jakobsen JC, et al. Prothrombin complex concentrate for reversal of oral anticoagulants in patients with oral anticoagulation-related critical bleeding: a systematic review of randomised clinical trials. Scand J Trauma Resusc Emerg Med. 2025;33(1):19.
9. Brill JB, Brenner M, Duchesne J, Roberts D, Ferrada P, Horer T, et al. The role of TEG and ROTEM in damage control resuscitation. Shock. 2021;56(1s):52-61.
10. Kornelsen E, Kuppermann N, Nishijima DK, Ren LY, Rumantir M, Gill PJ, et al. Effectiveness and safety of tranexamic acid in pediatric trauma: a systematic review and meta-analysis. Am J Emerg Med. 2022;55:103-10.
11. Jain V, Chari R, Maslovitz S, Farine D, Bujold E, Gagnon R, et al. Guidelines for the management of a pregnant trauma patient. J Obstet Gynaecol Can. 2015;37(6):553-74.
12. Morris MC, Niziolek GM, Baker JE, Huebner BR, Hanseman D, Makley AT, et al. Death by decade: establishing a transfusion ceiling for futility in massive transfusion. Journal of Surgical Research. 2020;252:139-46.
13. Zhu G, Chen F, Wang L, Cui W, Cai Y, Yang C, et al. Optimal range of systolic blood pressure in the emergent phase that reduces the negative outcomes of traumatic brain injury surgery. Journal of Neurorestoratology. 2024;12(2):100118.
14. McGovern Medical School HHH. Adult massive hemorrhage protocol. Department of Surgery. 2024.
2. Callum JL, Yeh CH, Petrosoniak A, McVey MJ, Cope S, Thompson T, et al. A regional massive hemorrhage protocol developed through a modified Delphi technique. CMAJ Open. 2019;7(3):E546-E61.
3. Schroll R, Swift D, Tatum D, Couch S, Heaney JB, Llado-Farrulla M, et al. Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients. Injury. 2018;49(1):15-9.
4. Strickland M, Nguyen A, Wu S, Suen SC, Mu Y, Del Rio Cuervo J, et al. Assessment of machine learning methods to predict massive blood transfusion in trauma. World J Surg. 2023;47(10):2340-6.
5. Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: a practice management guideline from the Eastern association for the surgery of trauma. Journal of Trauma and Acute Care Surgery. 2017;82(3):605-17.
6. Meizoso JP, Cotton BA, Lawless RA, Kodadek LM, Lynde JM, Russell N, et al. Whole blood resuscitation for injured patients requiring transfusion: a systematic review, meta-analysis, and practice management guideline from the Eastern association for the surgery of trauma. J Trauma Acute Care Surg. 2024;97(3):460-70.
7. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471-82.
8. Ovesen C, Purrucker J, Grundtvig J, Mikkelsen TB, Gluud C, Jakobsen JC, et al. Prothrombin complex concentrate for reversal of oral anticoagulants in patients with oral anticoagulation-related critical bleeding: a systematic review of randomised clinical trials. Scand J Trauma Resusc Emerg Med. 2025;33(1):19.
9. Brill JB, Brenner M, Duchesne J, Roberts D, Ferrada P, Horer T, et al. The role of TEG and ROTEM in damage control resuscitation. Shock. 2021;56(1s):52-61.
10. Kornelsen E, Kuppermann N, Nishijima DK, Ren LY, Rumantir M, Gill PJ, et al. Effectiveness and safety of tranexamic acid in pediatric trauma: a systematic review and meta-analysis. Am J Emerg Med. 2022;55:103-10.
11. Jain V, Chari R, Maslovitz S, Farine D, Bujold E, Gagnon R, et al. Guidelines for the management of a pregnant trauma patient. J Obstet Gynaecol Can. 2015;37(6):553-74.
12. Morris MC, Niziolek GM, Baker JE, Huebner BR, Hanseman D, Makley AT, et al. Death by decade: establishing a transfusion ceiling for futility in massive transfusion. Journal of Surgical Research. 2020;252:139-46.
13. Zhu G, Chen F, Wang L, Cui W, Cai Y, Yang C, et al. Optimal range of systolic blood pressure in the emergent phase that reduces the negative outcomes of traumatic brain injury surgery. Journal of Neurorestoratology. 2024;12(2):100118.
14. McGovern Medical School HHH. Adult massive hemorrhage protocol. Department of Surgery. 2024.
| Files | ||
| Issue | Vol 9 No 2 (2025): Spring (April) | |
| Section | Letter to the editor | |
| DOI | 10.18502/fem.v9i2.19200 | |
| Keywords | ||
| Trauma Transfusion Massive Hemorrhage Protocol | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Marcotte A, Bahreini M. Massive hemorrhage update: what is known and what we should know?. Front Emerg Med. 2025;9(2):e18.
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