ABSTRACT
Background : Massive bleeding(MB) is associated with coagulopathy and high mortality. Currently, there are diverse approaches to the management of MB. The main difference is the number of blood products in the transfusion packages, which include red blood cells(RBC), fresh frozen plasma(FFP) and platelet concentrates(PC). The use of hemostatic agents like fibrinogen concentrate(FC), tranexamic acid and prothrombin complex concentrate (PCC) has been shown to reduce mortality.Our MB protocol utilizes a ratio of 4RBC:4FFP:1PC in the initial transfusion package. Our hospital administrates approx. 12000 blood products/year. The anesthetics team is experienced with the use of Rotational thrombelastometry (ROTEM) in the management of MB. Aims : This study aimed to determine the use of blood components and hemostatic agents during MB in our hospital. Methods : We performed a retrospective review of MB cases from January 2018 to December 2020. Patient demographics, indications and laboratory records were analyzed. ROTEM guided transfusion was performed by the team of anesthesiologists managing the patient. Results : During this period, a total of 108 MB were detected, with an average of 36/year. The medium age for these events was 57.18 y (range of 18-88 y) and included 49 females and 59 males. MB were associated with surgery(57), cirrhotic complications(27), trauma(20), obstetric bleeding(4).The blood products used were 850 RBC(average 7.87/patient) and 169 PC(average 1.56/patient). Of the 510 FFP units(average 4.72/patient) that were thawed, 411(average 3.84/patient) were used. The remaining units were discarded. Tranexamic acid was used in 70 patients and CCP in 13.There was a favorable outcome in 83 cases and 25 patients died from the major bleeding event.A decrease in MB events was recorded during the COVID pandemic. Conclusions : The optimal way to resuscitate patients with MB remains unclear, and clinical trials are difficult to perform in this setting. We believe that uniform approach for the management of MB is deleterious to the best use of blood products.