Patient Blood Management Guidelines: Module 1

Critical Bleeding Massive Transfusion

| Executive summary |

Summary of Recommendations

The CRG developed recommendations (given below) where sufficient evidence was available from the systematic review of the literature. The recommendations have been carefully worded to reflect the strength of the body of evidence. Each recommendation has been given a grade, using the following definitions, which were set by the NHMRC:

  • Grade A  –   Body of evidence can be trusted to guide practice
  • Grade B   –   Body of evidence can be trusted to guide practice in most situations
  • Grade C   –   Body of evidence provides some support for recommendation(s)
    but care should be taken in its application
  • Grade D   –   Body of evidence is weak and recommendations must be applied with caution.
No. Grade Recommendation Relevant section of document
R1 C It is recommended that institutions develop an MTP that includes the dose, timing and ratio of blood component therapy for use in trauma patients with, or at risk of, critical bleeding requiring massive transfusion (Grade C). 4-5 4.2
R2 B C The routine use of rFVIIa in trauma patients with critical bleeding requiring massive transfusion is not recommended because of its lack of effect on mortality (Grade B)6 and variable effect on morbidity (Grade C).6 4.6

MTP, massive transfusion protocol; rFVIIa, recombinant activated factor VII