Massive Hemorrhage Protocol : A Practical Approach to the Bleeding Trauma Patient - 22/11/22

Doi : 10.1016/j.emc.2022.09.010

Andrew Petrosoniak, MD, MSc, FRCPC ^a,^⁎ , Katerina Pavenski, MD, FRCPC ^b, Luis Teodoro da Luz, MD, MSc ^c, Jeannie Callum, MD, FRCPC ^d
^a Department of Emergency Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
^b Department of Laboratory Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
^c Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room H1 71, Toronto, Ontario M4N 3M5, Canada
^d Queen’s University, 88 Stuart Street, Kingston, Ontario K7L 3N6, Canada

^∗Corresponding author.

Résumé

Damage-control resuscitation is the standard of care for the hemorrhaging trauma patient. This approach combines rapid hemostasis and early-ratio-based blood product administration. These patients often require initiation of a massive hemorrhage protocol to support the systematic and coordinated delivery of care during this critical phase of resuscitation. Emerging evidence supports that this includes more than blood product administration alone but rather a comprehensive suite of treatments. In this article, we review the existing evidence and provide a pragmatic framework, the 7 Ts of massive hemorrhage protocol, to guide the care of patients with life-threatening traumatic hemorrhage.

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Keywords : Damage control resuscitation, Trauma, Massive hemorrhage protocol, Resuscitation