Outline for management of catastrophic bleeding in patients on extracorporeal circulation
| Recommended actions . |
|---|
| Predict |
| Identification of high‐risk patients based on patient and procedural characteristics |
| Prediction rules |
| Prevent |
| Tranexamic acid |
| Prepare |
| Intravenous access |
| Large‐bore peripheral and central |
| Rapid infusers |
| Temperature control |
| Fluid and body warmers; warm room |
| Hemodynamic support |
| Infusion pumps |
| Vasopressors (eg, phenylephrine, norepinephrine, vasopressin) |
| Notify |
| Blood bank |
| Extra help |
| To check and infuse blood; send bloodwork; resuscitate, etc |
| Protect |
| Protect against end organ injury and severe hemostatic derangement |
| Reverse anticoagulation |
| Maintain minimal acceptable perfusion pressure |
| Vasopressors |
| Support hemostasis with allogeneic blood transfusions |
| Initiate massive bleeding/transfusion protocol |
| Ratio-based (1:1:1) transfusion guided by coagulation assays |
| Maintain acid/base and electrolyte (calcium) balance |
| Frequent arterial blood gas measurement |
| Maintain normothermia |
| Promote |
| Promote hemostasis using targeted hemostatic therapy |
| Guided by standard and POC coagulation assays |
| Combination of allogeneic and factor concentrates |
| Recommended actions . |
|---|
| Predict |
| Identification of high‐risk patients based on patient and procedural characteristics |
| Prediction rules |
| Prevent |
| Tranexamic acid |
| Prepare |
| Intravenous access |
| Large‐bore peripheral and central |
| Rapid infusers |
| Temperature control |
| Fluid and body warmers; warm room |
| Hemodynamic support |
| Infusion pumps |
| Vasopressors (eg, phenylephrine, norepinephrine, vasopressin) |
| Notify |
| Blood bank |
| Extra help |
| To check and infuse blood; send bloodwork; resuscitate, etc |
| Protect |
| Protect against end organ injury and severe hemostatic derangement |
| Reverse anticoagulation |
| Maintain minimal acceptable perfusion pressure |
| Vasopressors |
| Support hemostasis with allogeneic blood transfusions |
| Initiate massive bleeding/transfusion protocol |
| Ratio-based (1:1:1) transfusion guided by coagulation assays |
| Maintain acid/base and electrolyte (calcium) balance |
| Frequent arterial blood gas measurement |
| Maintain normothermia |
| Promote |
| Promote hemostasis using targeted hemostatic therapy |
| Guided by standard and POC coagulation assays |
| Combination of allogeneic and factor concentrates |