ICU SAQs · Resuscitation & shock
Massive transfusion and tranexamic acid in trauma
A CICM Second-Part SAQ on massive transfusion — PROPPR (1:1:1 vs 1:1:2; 24-hour mortality NS; fewer exsanguination deaths), CRASH-2 (1 g then 1 g; 3-hour window), fibrinogen, ionised calcium, and TRALI as sourced.
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Prompt
A 25-year-old motorcyclist arrives in class III haemorrhagic shock after a crash. The massive haemorrhage protocol is activated. Outline the principles of massive transfusion, including the evidence for the component ratio and for tranexamic acid.
Question
A 25-year-old motorcyclist arrives in class III haemorrhagic shock after a crash. The massive haemorrhage protocol is activated. Outline the principles of massive transfusion, including the evidence for the component ratio and for tranexamic acid.
[1]References9ShowHide
- [1]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients (CRASH-2). Lancet, 2010.PMID 20554319
- [2]Roberts I, Shakur H, Afolabi A, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients (CRASH-2 exploratory). Lancet, 2011.PMID 21439633
- [3]Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio (PROPPR). JAMA, 2015.PMID 25647203
- [7]HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT). Lancet, 2020.PMID 32563378
- [13]Moore HB, Tessmer MT, Moore EE, et al. Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock J Trauma Acute Care Surg, 2020.PMID 32317575
- [15]Winearls J, Reade MC, McQuilten Z, et al. Fibrinogen in traumatic haemorrhage Curr Opin Anaesthesiol, 2021.PMID 34091461
- [22]Rossaint R, Afshari A, Bouillon B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition Crit Care, 2023.PMID 36859355
- [24]Vlaar AP, Juffermans NP Transfusion-related acute lung injury: a clinical review Lancet, 2013.PMID 23642914
- [26]Santiago R, et al. Resuscitating massive transfusion knowledge: An update for the pharmacist Am J Health Syst Pharm, 2025.PMID 40580496