Patient blood management guideline for adults with critical bleeding

Published by National Blood Authority on Nov 27, 2023

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ISBN 978-0-6453281-1-0 (electronic copy) 

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Abstract

v1.4:  21/11/2023

Please note this guideline is maintained electronically on MAGICapp. Any downloaded or printed version is only current as at the day of download/printing.

To keep up to date with the latest changes to this guideline click on subscribe at https://app.magicapp.org/#/guideline/Evqmmn

 

Language

en-au

PICOS

PICO 1.1

Population
People with critical bleeding, specifically those with ongoing bleeding who fail to achieve adequate haemostasis despite surgical management and appropriate blood component therapy (trauma setting)
Intervention
recombinant activated factor VII
Comparator
standard best practice without recombinant activated factor VII
Outcomes

PICO 1.1

Population
People with critical bleeding (trauma setting)
Intervention
Defined MHP
Comparator
No defined MHP
Outcomes

PICO 1.1

Population
People with critical bleeding (any setting)
Intervention
Temperature
Comparator
N/A
Outcomes

PICO 1.2

Population
People with critical bleeding (non-trauma setting)
Intervention
Defined MHP
Comparator
No defined MHP
Outcomes

PICO 1.2

Population
People with critical bleeding, specifically those with ongoing bleeding who fail to achieve adequate haemostasis despite surgical management and appropriate blood component therapy (medical emergency)
Intervention
recombinant activated factor VII
Comparator
standard best practice without recombinant activated factor VII
Outcomes

PICO 1.2

Population
People with critical bleeding (any setting)
Intervention
Acid-base status
Comparator
N/A
Outcomes

PICO 1.3

Population
People with critical bleeding (any setting)
Intervention
Ionised calcium
Comparator
N/A
Outcomes

PICO 1.3

Population
People with critical bleeding, specifically those with ongoing bleeding who fail to achieve adequate haemostasis despite surgical management and appropriate blood component therapy (haematology/oncology setting)
Intervention
recombinant activated factor VII
Comparator
standard best practice without recombinant activated factor VII
Outcomes

PICO 1.3

Population
People with critical bleeding (paediatric setting)
Intervention
Defined MHP
Comparator
No defined MHP
Outcomes

PICO 1.4

Population
People with critical bleeding (any setting)
Intervention
Haemoglobin
Comparator
N/A
Outcomes

PICO 1.4

Population
People with critical bleeding (any setting)
Intervention
Defined MHP
Comparator
No defined MHP
Outcomes

PICO 1.4

Population
People with critical bleeding, specifically those with ongoing bleeding who fail to achieve adequate haemostasis despite surgical management and appropriate blood component therapy (cardiac setting)
Intervention
recombinant activated factor VII
Comparator
standard best practice without recombinant activated factor VII
Outcomes

PICO 1.5

Population
People with critical bleeding (any setting)
Intervention
Platelet count
Comparator
N/A
Outcomes

PICO 1.5

Population
People with critical bleeding, specifically those with ongoing bleeding who fail to achieve adequate haemostasis despite surgical management and appropriate blood component therapy (obstetrics and maternity setting)
Intervention
recombinant activated factor VII
Comparator
standard best practice without recombinant activated factor VII
Outcomes

PICO 1.6

Population
People with critical bleeding (any setting)
Intervention
PT/INR
Comparator
N/A
Outcomes

PICO 1.7

Population
People with critical bleeding (any setting)
Intervention
APTT
Comparator
N/A
Outcomes

PICO 1.8

Population
People with critical bleeding (any setting)
Intervention
Fibrinogen levels
Comparator
N/A
Outcomes

PICO 2.1

Population
People with critical bleeding (trauma setting)
Intervention
High ratio (1:1:1) of blood components
Comparator
Lower ratios of blood components
Outcomes

PICO 2.1

Population
People with critical bleeding (trauma setting)
Intervention
Antifibrinolytics
Comparator
Placebo or no antifibrinolytics
Outcomes

PICO 2.2

Population
People with critical bleeding (surgical setting)
Intervention
High ratio (1:1:1) of blood components
Comparator
Lower ratios of blood components
Outcomes

PICO 2.2

Population
People with critical bleeding (medical emergency)
Intervention
Antifibrinolytics
Comparator
Placebo or no antifibrinolytics
Outcomes

PICO 2.3

Population
People with critical bleeding (paediatrics, trauma setting)
Intervention
High ratio (1:1:1) of blood components
Comparator
Lower ratios of blood components
Outcomes

PICO 2.3

Population
People with critical bleeding (medical emergency)
Intervention
Antifibrinolytics
Comparator
Placebo or no antifibrinolytics
Outcomes

PICO 2.4

Population
People with critical bleeding (obstetrics and maternity)
Intervention
Antifibrinolytics
Comparator
Placebo or no antifibrinolytics
Outcomes

PICO 2.4

Population
People at risk of critical bleeding (any setting)
Intervention
Increasing red blood cell transfusion volumes
Comparator
Outcomes

PICO 3.1

Population
People with critical bleeding (any setting)
Intervention
Viscoelastic haemostatic assays
Comparator
Standard best practice care (blood component therapy guided by MHP protocol or standard laboratory tests)
Outcomes

PICO 3.1

Population
People with critical bleeding (trauma setting)
Intervention
Fresh frozen plasma
Comparator
No frozen frozen plasma (or varying administration of)
Outcomes

PICO 3.2

Population
People with critical bleeding (trauma setting)
Intervention
Viscoelastic haemostatic assays
Comparator
Standard best practice care (blood component therapy guided by MHP protocol or standard laboratory tests)
Outcomes

PICO 3.2

Population
People with critical bleeding (trauma setting)
Intervention
Cryoprecipitate
Comparator
No cryoprecipitate (or varying administration of)
Outcomes

PICO 3.3

Population
People with critical bleeding (surgical setting)
Intervention
Viscoelastic haemostatic assays
Comparator
Standard best practice care (blood component therapy guided by MHP protocol or standard laboratory tests)
Outcomes

PICO 3.3

Population
People with critical bleeding (trauma setting)
Intervention
Fibrinogen concentrate
Comparator
No fibrinogen concentrate (or varying administration of)
Outcomes

PICO 3.4

Population
People with critical bleeding (obstetrics and maternity)
Intervention
Viscoelastic haemostatic assays
Comparator
Standard best practice care (blood component therapy guided by MHP protocol or standard laboratory tests)
Outcomes

PICO 3.4

Population
People with critical bleeding (surgical setting)
Intervention
Fibrinogen concentrate
Comparator
No fibrinogen concentrate (or varying administration of)
Outcomes

PICO 3.5

Population
People with critical bleeding (obstetrics and maternity)
Intervention
Fibrinogen concentrate
Comparator
No fibrinogen concentrate (or varying administration of)
Outcomes

PICO 3.6

Population
People with critical bleeding (pediatrics, surgical setting)
Intervention
Fibrinogen concentrate
Comparator
No fibrinogen concentrate (or varying administration of)
Outcomes

PICO 3.7

Population
People with critical bleeding (trauma setting)
Intervention
Prothrombin complex
Comparator
No prothrombin complex (or varying administration of)
Outcomes

PICO 3.8

Population
People with critical bleeding (any setting)
Intervention
Platelets
Comparator
No platelets (or varying administration of)
Outcomes

PICO 4.1

Population
People with critical bleeding (trauma setting)
Intervention
Cell salvage
Comparator
No cell salvage
Outcomes

PICO 4.2

Population
People with critical bleeding (medical emergency)
Intervention
Cell salvage
Comparator
No cell salvage
Outcomes