Highly Accessed Review

Clinical review: Canadian National Advisory Committee on Blood and Blood Products - Massive Transfusion Consensus Conference 2011: report of the panel

Walter H Dzik1*, Morris A Blajchman23, Dean Fergusson4, Morad Hameed5, Blair Henry6, Andrew W Kirkpatrick7, Teresa Korogyi8, Sarvesh Logsetty9, Robert C Skeate10, Simon Stanworth11, Charles MacAdams12 and Brian Muirhead13

Author Affiliations

1 Blood Transfusion Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA

2 Canadian Blood Services, Southern Ontario Region, Departments of Pathology and Medicine, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5

3 NHLBI TMH Clinical Trials Network, Bethesda, MD, USA

4 Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Faculty of Medicine, University of Ottawa, 6th Floor Critical Care Wing, Office W6119, 501 Smyth Road, Box 201, Ottawa, Ontario, Canada K1H 8L6

5 General Surgery Residency Program, Department of Surgery and Critical Care Medicine, University of British Columbia, Trauma Services, Vancouver General Hospital, 855 W 12 Avenue, Vancouver, British Columbia, Canada V5Z 1M9

6 Sunnybrook Health Sciences Centre, Joint Centre for Bioethics, Department of Family and Community Medicine, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room H2-39, Toronto, Ontario, Canada M4N 3M5

7 Department of Critical Care Medicine and Surgery, University of Calgary, Regional Trauma Services, Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta, Canada T2N 2T9

8 Emergency Department, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5

9 Manitoba Firefighters' Burn Unit, University of Manitoba, GC401A, 820 Sherbrook Avenue, Winnipeg, Manitoba, Canada R3A1R9

10 Canadian Blood Services Central Ontario Region, Department of Laboratory Medicine and Pathobiology, University of Toronto, 67 College Street, Toronto, Ontario, Canada M5G 2M1

11 Department of Haematology, John Radcliffe Hospital, University of Oxford, UK

12 Perioperative Blood Conservation Program Calgary Zone, Department of Anesthesia, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9

13 Transfusion Practices Committee, Blood Conservation Servcies, Winnipeg Regional Health Authority, Department of Anesthesiology, University of Manitoba, 347 Cambridge Street, Winnipeg, Manitoba, Canada R3M 3E8

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Critical Care 2011, 15:242  doi:10.1186/cc10498

Published: 8 December 2011

Abstract

In June 2011 the Canadian National Advisory Committee on Blood and Blood Products sponsored an international consensus conference on transfusion and trauma. A panel of 10 experts and two external advisors reviewed the current medical literature and information presented at the conference by invited international speakers and attendees. The Consensus Panel addressed six specific questions on the topic of blood transfusion in trauma. The questions focused on: ratio-based blood resuscitation in trauma patients; the impact of survivorship bias in current research conclusions; the value of nonplasma coagulation products; the role of protocols for delivery of urgent transfusion; the merits of traditional laboratory monitoring compared with measures of clot viscoelasticity; and opportunities for future research. Key findings include a lack of evidence to support the use of 1:1:1 blood component ratios as the standard of care, the importance of early use of tranexamic acid, the expected value of an organized response plan, and the recommendation for an integrated approach that includes antifibrinolytics, rapid release of red blood cells, and a foundation ratio of blood components adjusted by results from either traditional coagulation tests or clot viscoelasticity or both. The present report is intended to provide guidance to practitioners, hospitals, and policy-makers.