Table 1 Massive transfusion protocol in Central Norway
Criteria for initiation of transfusion protocol | Suspected severe bleeding and hypotension (systolic blood pressure < 90 mmHg) or other signs of shock. |
|---|---|
Transfusion protocol | 750 mL packed red blood cell concentrate + 600 mL of Octaplasma [1] + 250 mL platelet concentrate (repeat as needed) Fibrinogen concentrate (e.g. Riastap or Fibryga) 2–4 g (repeat as needed). |
Adjuncts included in protocol | Tranexamic acid 1 g (bolus) + tranexamic acid 1 g (infusion over 8 hours) Calcium gluconate (20–40 mL, repeat as needed for plasma Ca2+ concentration < 1.1 mmol/L) Consider specific drugs for reversal of anticoagulants (e.g. prothrombin complex concentrate for Warfarin or Idarusizumab for Dabigatran) |