Management for massive hemorrhage during surgery

Abstract

Although the incidence of massive hemorrhage during surgery is low, the prognosis of massive hemorrhage is poor. When we encounter massive hemorrhage, systematic approach is mandatory. Physicians, nurses, and technicians at the scene, staff in the transfusion department, and the staff in the blood center work as a team. Achieving hemostasis by surgical maneuvers and restoration of blood volume to maintain organ perfusion and oxygenation is essential. If the patient requires vasopressors and lack of crossmatched red cell concentrate (RCC), type-specific RCC should be used. When the situation is life-threatening, un-crossmatched typecompatible RCC should be used. To correct coagulopathy, judicious use of blood components such as fresh frozen plasma and platelet concentrates is mandatory. It may require cryoprecipitate, a fibrinogen product, when fibrinogen level is very low. To improve patient's outcome, understanding of current blood transfusion guidelines and institutional simulation is important.