Massive transfusion protocol

Massive hemorrhage can be a significant challenge that requires immediate multidisciplinary response and communication between clinicians, nurses, paramedics, laboratory testing, and blood banks. Massive hemorrhage requires replacement by massive transfusion. Indications of massive transfusion include severe trauma, major hepatic surgery, cardiac and major vascular surgery, cancer surgery, spine surgery, congenital or acquired coagulopathic surgical patients, and obstetric hemorrhage. Massive transfusion protocol (MTP) was developed in trama initially, but also applied in various massive hemorrhage settings. MTP consists of blood products with predefined ratio of blood components, multidisciplinary approach including surgeon, anesthesiologist, hematologist, and blood bank personnel. The purpose of MTP is to provide blood products promptly to treat coagulopathy early by transfusion with a predefined ratio of red blood cells (RBCs), plasma, and platelets (PLTs) similar to the whole blood components. Although the evidence of current practice in massive hemorrhage and MTP are mostly based on trauma experience, MTP has been widely adpoted in many other clinical settings required massive transfusion. In this chapter, we discuss the optimal ratios and components of blood products, the initiation, continuation, and termination of the protocol, MTPs for specific patient groups, and the monitoring of outcomes, performance, and complications, of MTPs.