Share
array:24 [ "pii" => "S2341192923001257" "issn" => "23411929" "doi" => "10.1016/j.redare.2023.08.001" "estado" => "S300" "fechaPublicacion" => "2023-08-01" "aid" => "1487" "copyright" => "Elsevier Spain, Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) and Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:409-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935623001160" "issn" => "00349356" "doi" => "10.1016/j.redar.2023.05.001" "estado" => "S300" "fechaPublicacion" => "2023-08-01" "aid" => "1487" "copyright" => "Elsevier Spain, Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Anestesiol Reanim. 2023;70:409-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Documento de consenso</span>" "titulo" => "Documento multidisciplinar de consenso sobre el manejo de la hemorragia masiva. Primera actualización 2023 (documento HEMOMAS-II)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "409" "paginaFinal" => "421" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Multidisciplinary consensus document on the management of massive haemorrhage. First update 2023 (document HEMOMAS-II)" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3905 "Ancho" => 2508 "Tamanyo" => 547948 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo de la selección de artículos incluidos en la revisión del documento.</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">(*) Búsqueda manual derivada: búsqueda de artículos incluidos para la revisión del documento basada en las citas bibliográficas existentes en los artículos y guías clínicas seleccionados. (**) Artículos referenciados en las justificaciones de las recomendaciones, sin incluir las referencias de la introducción ni de la metodología.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan V. Llau, César Aldecoa, Emilia Guasch, Pascual Marco, Pilar Marcos-Neira, Pilar Paniagua, José A. Páramo, Manuel Quintana, F. Javier Rodríguez-Martorell, Ainhoa Serrano" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Juan V." "apellidos" => "Llau" ] 1 => array:2 [ "nombre" => "César" "apellidos" => "Aldecoa" ] 2 => array:2 [ "nombre" => "Emilia" "apellidos" => "Guasch" ] 3 => array:2 [ "nombre" => "Pascual" "apellidos" => "Marco" ] 4 => array:2 [ "nombre" => "Pilar" "apellidos" => "Marcos-Neira" ] 5 => array:2 [ "nombre" => "Pilar" "apellidos" => "Paniagua" ] 6 => array:2 [ "nombre" => "José A." "apellidos" => "Páramo" ] 7 => array:2 [ "nombre" => "Manuel" "apellidos" => "Quintana" ] 8 => array:2 [ "nombre" => "F. Javier" "apellidos" => "Rodríguez-Martorell" ] 9 => array:2 [ "nombre" => "Ainhoa" "apellidos" => "Serrano" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192923001257" "doi" => "10.1016/j.redare.2023.08.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001257?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623001160?idApp=UINPBA00004N" "url" => "/00349356/0000007000000007/v1_202308090807/S0034935623001160/v1_202308090807/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192923001178" "issn" => "23411929" "doi" => "10.1016/j.redare.2022.04.004" "estado" => "S300" "fechaPublicacion" => "2023-08-01" "aid" => "1482" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:422-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Epidural analgesia and lumbar tattoos: 20 years of uncertainty" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "422" "paginaFinal" => "423" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Analgesia epidural y tatuajes lumbares: 20 años de incertidumbre" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Mesa Suárez, M. Pulido Barba, D. Portilla Huerta" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Mesa Suárez" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Pulido Barba" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Portilla Huerta" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935623001111" "doi" => "10.1016/j.redar.2022.04.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623001111?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001178?idApp=UINPBA00004N" "url" => "/23411929/0000007000000007/v1_202309151027/S2341192923001178/v1_202309151027/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192923001166" "issn" => "23411929" "doi" => "10.1016/j.redare.2022.05.005" "estado" => "S300" "fechaPublicacion" => "2023-08-01" "aid" => "1481" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:404-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Validation of Point-of-Care ultrasound in the diagnosis of a diaphragmatic hernia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "404" "paginaFinal" => "408" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación de la ecografía Point-of-Care para el diagnóstico de hernia diafragmática: a propósito de un caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3595 "Ancho" => 2508 "Tamanyo" => 724499 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Point-of-Care ultrasound: in B-mode, showing the right (A) and left (B) diaphragm at the level of the second intercostal space in the supine position; and in M-mode, in the supine (C) and sitting (D) position, showing normal diaphragmatic thickening.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Oliver-Forniés, A. Centeno-Pérez, M. Martínez García, M. Fajardo Pérez, F.B. de la Quintana Gordon" "autores" => array:5 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Oliver-Forniés" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Centeno-Pérez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Martínez García" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Fajardo Pérez" ] 4 => array:2 [ "nombre" => "F.B." "apellidos" => "de la Quintana Gordon" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S003493562300110X" "doi" => "10.1016/j.redar.2022.05.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S003493562300110X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001166?idApp=UINPBA00004N" "url" => "/23411929/0000007000000007/v1_202309151027/S2341192923001166/v1_202309151027/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Multidisciplinary consensus document on the management of massive haemorrhage. First update 2023 (document HEMOMAS-II)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "409" "paginaFinal" => "421" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan V. Llau, César Aldecoa, Emilia Guasch, Pascual Marco, Pilar Marcos-Neira, Pilar Paniagua, José A. Páramo, Manuel Quintana, F. Javier Rodríguez-Martorell, Ainhoa Serrano" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Juan V." "apellidos" => "Llau" "email" => array:1 [ 0 => "juanvllau@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "César" "apellidos" => "Aldecoa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Emilia" "apellidos" => "Guasch" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Pascual" "apellidos" => "Marco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Pilar" "apellidos" => "Marcos-Neira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Pilar" "apellidos" => "Paniagua" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "José A." "apellidos" => "Páramo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "Manuel" "apellidos" => "Quintana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "F. Javier" "apellidos" => "Rodríguez-Martorell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "Ainhoa" "apellidos" => "Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">j</span>" "identificador" => "aff0050" ] ] ] ] "afiliaciones" => array:10 [ 0 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario Doctor Peset, València, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario Río Hortega, Valladolid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hemoterapia y Hematología, Hospital General Universitario Dr. Balmis, Alicante, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Hematología y Hemoterapia, Clínica Universidad de Navarra, Pamplona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "UGC Hematología y Hemoterapia, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Medicina Intensiva, Hospital Clínico Universitario, València, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Documento multidisciplinar de consenso sobre el manejo de la hemorragia masiva. Primera actualización 2023 (documento HEMOMAS-II)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3905 "Ancho" => 2508 "Tamanyo" => 547948 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flowchart of bibliographic search.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(*) Manual search: identification of eligible article after reviewing the references included in selected articles and guidelines. (**) Articles cited in the recommendation rationale, without including citations in the introduction or methodology sections.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The management of massive haemorrhage (MH) involves implementing several strategies to control bleeding, rapidly replenish blood loss, and minimise potentially life-threatening coagulopathy.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The recent creation and dissemination of multidisciplinary protocols and the publication of excellent guidelines<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> has improved MH management, particularly in the early stages of haemorrhagic shock. However, uncontrolled traumatic bleeding remains the leading preventable cause of death.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2015, a multidisciplinary group was formed to review the existing literature and prepare a document that would facilitate decision-making for all those involved in the treatment of MH.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Endorsed by the Spanish scientific societies of Anaesthesiology and Resuscitation (SEDAR), Intensive and Critical Medicine and Coronary Units (SEMICYUC), and Thrombosis and Haemostasis (SETH), the group drafted 47 recommendations or suggestions for the management of MH.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2021, given the time elapsed and the advances made in many aspects of MH management, the scientific societies decided it was time to update the existing guidelines using a special methodology that has allowed the expert panel to review and change, if needed, the existing recommendations.</p><p id="par0025" class="elsevierStylePara elsevierViewall">These guidelines address MH in multiple trauma patients, in the perioperative setting, and in intensive care; however, like the previous guidelines, obstetric haemorrhage, bleeding in paediatric patients, and intestinal bleeding have been excluded due to their particular characteristics and management strategies.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A group of 10 experts (the authors of this manuscript) met in May 2021 to establish the process for reviewing the original guidelines, and agreed to update the previous consensus recommendations on the basis of other clinical practice guidelines and a review of the latest literature. The methodology used was based on elements of the ADAPTE method that has been described in detail elsewhere,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and involves searching for and adapting other guidelines and published articles. For this project, the working group first identified the skills and resources needed prior to beginning the adaptation process. This was followed by the adaptation phase, in which the literature was searched for eligible guidelines, the recommendations sourced were uploaded to a matrix and, if appropriate, were adapted to the context of our guidelines. The topics to be covered in these guidelines were those included in the original document. The last phase of ADAPTE, where the opinion of decision-makers affected by the updated guide is obtained, was excluded.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The group searched PubMed and EMBASE (January 2014–June 2021; see Supplementary material and <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) to identify clinical practice guidelines published in scientific journals and recommendations from scientific societies related to the management of MH.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">After protocolizing the strategy used to review the results of the bibliographic search and the recommendations of the original guideline (peer review), the results were shared so that the group could agree on the changes needed based on the latest evidence contained in other recommendations (see details of the review protocol in Supplementary material).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Only 1 of the 47 recommendations included in the original document was maintained without change. In all the remaining recommendations the group found it necessary to change the wording and/or the grade of recommendation and/or the level of evidence. Seven recommendations were eliminated, some were amalgamated into a single recommendations, and others were expanded based on the available evidence. The final updated guidelines contain 41 recommendations distributed in 14 sections with 61 statements (38 recommendations, 2 with level A evidence, and 23 suggestions). Tables 1MS and 2MS in the supplementary material compare the original and updated guidelines.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Recommendations and rationale</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Definition and evaluations</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Recommendation 1</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">To evaluate the extent and/or severity of bleeding in surgical patients we recommend visually examining the surgical field to identify extensive microvascular bleeding, and in trauma patients we recommend evaluating the mechanism of injury, the anatomical pattern of injury, and the initial response to resuscitation. (1C)</span></p><p id="par0055" class="elsevierStylePara elsevierViewall">In patients at risk of MH, bleeding should be monitored by clinical examination and quantification.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In trauma patients, the mechanism and anatomical pattern of injury, and the initial response to resuscitation should also be analysed. These measures can help predict the need to activate massive transfusion protocols (MTP).<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,10</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Recommendation 2</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest using the Trauma Associated Severe Hemorrhage (TASH) score to promptly identify trauma patients who may benefit from the activation of a massive transfusion protocol (cut-off score 15), preferably in conjunction with a decrease in clot firmness shown by rotational thromboelastometry or TEG, if available. (2C)</span></p><p id="par0065" class="elsevierStylePara elsevierViewall">It is crucial to rapidly identify patients at risk of developing MH and requiring massive transfusion (MT) in order to immediately activate an MTP and improve prognosis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Several scales have been developed to assess multiple trauma patients, including the TASH score, which measures clinical (blood pressure and heart rate, among others) and analytical (haemoglobin, base excess) parameters and has been shown to correctly identify 88.8% of patients who will require MT.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Viscoelastic tests (VET) can also help predict the need for MTP activation in trauma patients.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Recommendation 3</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest using the "resuscitation intensity" criterion, defined as the transfusion of at least 4 units of packed red blood cells in 1 hour, to promptly identify non-trauma patients that would benefit from activation of the massive transfusion protocol. (2C)</span></p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In the prehospital setting, we suggest using a "Shock Index” score of 1 or higher to indicate the need to activate the massive transfusion protocol. (2C)</span></p><p id="par0090" class="elsevierStylePara elsevierViewall">In non-trauma patients, experts suggest using the <span class="elsevierStyleItalic">resuscitation intensity</span> criterion of 3−4 packed red blood cells (RBC) per hour as an indicator of bleeding severity.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The shock index (SI) (heart rate divided by systolic blood pressure) is the only validated risk scale that exclusively uses clinical variables, and is considered very useful in the prehospital setting. An SI score of 1 higher predicts early mortality.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,14</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Recommendation 4</span><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hospitals should develop multidisciplinary massive transfusion protocols with evidence-based treatment algorithms that include activation and deactivation criteria and transfusion targets, and should consider transitioning to resuscitation guided by laboratory data or viscoelastic tests as soon as possible. We also recommend launching information campaigns, providing training for the teams involved, and periodically evaluating their effectiveness and compliance with the hospital’s quality and safety programs. (1B)</span></p><p id="par0105" class="elsevierStylePara elsevierViewall">The establishment and application of multidisciplinary MTPs has been shown to reduce the rate of blood transfusions and mortality in trauma patients.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a> Experts recommend reviewing MTPs regularly in the context of quality and safety standards.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,17</span></a> Other MH scenarios involving refractory bleeding and suspected coagulopathy could also benefit from these protocols<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> by allowing clinicians to coordinate their efforts and effectively control MH.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">When developing MPTs, experts recommend transitioning from an algorithm based on fixed levels of blood components to another guided by laboratory data or VET results, which would reduce blood transfusions and patient morbidity and improve coagulopathy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Recommendation 5</span><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In patients presenting massive haemorrhage, we recommend basing the initial assessment on the clinical history and anamnesis (if possible), and start serial monitoring of blood pressure, heart rate, and serum lactate or base deficit in order to assess tissue perfusion and the degree of hypovolemic shock. (1C)</span></p><p id="par0120" class="elsevierStylePara elsevierViewall">Dynamic monitoring of tissue perfusion includes blood pressure, heart rate, oxygen saturation, and electrocardiography, in addition to clinical signs and symptoms.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Serial determination of serum lactate and base deficit is also recommended.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Although these parameters may not strictly correlate with the severity of bleeding, they do correlate with the degree of hypoperfusion and tissue hypoxia.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Temperature management</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Recommendation 6</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In patients presenting massive haemorrhage, we recommend routine temperature monitoring and rapid application of measures to prevent heat loss and hypothermia and to maintain core temperature above 35 °C. (1B)</span></p><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Measures to prevent hypothermia include removing wet clothing, covering the patient, increasing room temperature, using forced air blankets or circulating-water mattresses, and rapid infusion warmers for all fluids administered during mass transfusion. Extracorporeal warming systems can also be considered in patients with severe hypothermia and high risk of cardiac arrest. (2C)</span></p><p id="par0135" class="elsevierStylePara elsevierViewall">Maintaining normothermia reduces bleeding and transfusion requirements,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and should be a priority in patients with MH<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> due to the association between hypothermia (core temperature below 35 °C) and acidosis, hypotension, and coagulopathy. Systematic monitoring of core temperature will indicate the effectiveness of measures to combat hypothermia, such fluid warmers, forced air warming systems or circulating-water mattresses.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is also important to warm RBCs and other blood products before they are administered.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Fluid therapy</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Recommendation 7</span><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend the early administration of fluid therapy, preferably isotonic crystalloids, in patients with severe bleeding and hypotension. (1A)</span></p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In patients with severe traumatic bleeding, balanced crystalloid solutions should be used instead of saline solutions. (1B)</span></p><p id="par0150" class="elsevierStylePara elsevierViewall">Administering fluids to replace volume is the first measure to be taken in MH,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> as these patients are less tolerant of hypovolemia than anaemia.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Crystalloids (Table 3MS, supplementary material) are the fluids of choice due to their clinical efficacy, moderate adverse effects, and low cost. There are insufficient data to suggest that the use of a colloid solution improves prognosis in patients with haemorrhagic shock,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and some authors have reported adverse effects such as allergic reactions (especially with gelatines), coagulation disorders, and kidney failure.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Balanced solutions in multiple trauma patients have been associated with greater improvements in acid-base balance and hyperchloremia at 24 h than 0.9% saline solution,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and a better cost-benefit ratio.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Although studies published after the literature review performed for this update suggest that both solutions could be effective in critically ill patients,<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,24</span></a> we prefer balanced over saline solution in the management of MH in multiple trauma patients. If saline is used, no more than 1–1.5 l should be administered.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,19</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Recommendation 8</span><p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend avoiding hypotonic crystalloid solutions such as lactated Ringer's in patients with severe traumatic brain injury. (1B)</span></p><p id="par0170" class="elsevierStylePara elsevierViewall">Hypotonic solutions, which are less expansive than isotonic and hypertonic solutions and increase the volume of free water, should be avoided in patients with severe traumatic brain injury (TBI) because they may increase mortality compared to 0.9% saline.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,25,26</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Recommendation 9</span><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest avoiding hypertonic solutions for fluid resuscitation in patients with severe traumatic brain injury. (2C)</span></p><p id="par0180" class="elsevierStylePara elsevierViewall">Hypertonic saline is a first-line measure to temporarily reduce intracranial pressure, but it should not be used as the primary resuscitation fluid for haemorrhagic shock because it does not improve survival or cognitive outcomes.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Recommendation 10</span><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Synthetic colloids should be used sparingly. (1C)</span></p><p id="par0190" class="elsevierStylePara elsevierViewall">The administration of synthetic colloids can aggravate coagulopathy due to their negative effect on haemostasis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">These colloids are thought to be more effective than crystalloids at restoring intravascular volume and reducing dosing requirements,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> and are therefore suggested when the crystalloid-vasopressor combination fails to maintain basic tissue perfusion. However, they show no mortality benefit<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> and it remains unclear which solution should be first choice.</p><p id="par0200" class="elsevierStylePara elsevierViewall">Following the withdrawal of hydroxyethyl starches, the only synthetic colloids currently used are gelatines.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Recommendation 11</span><p id="par0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend avoiding the routine use of albumin for volume replacement in patients with massive haemorrhage. (1C)</span></p><p id="par0210" class="elsevierStylePara elsevierViewall">There is no evidence that albumin is more effective than other solutes. It is also expensive and associated with potential risks, so it should not be the fluid of choice for volume resuscitation in MH.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Although it has been suggested as a second-line fluid in septic patients after initial administration of large volumes of crystalloids,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> this recommendation cannot be extrapolated to MH.</p><p id="par0215" class="elsevierStylePara elsevierViewall">A subgroup analysis of the SAFE study<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> suggested that the use of 4% albumin in TBI patients increased the risk of death, possibly due to its hypo-osmolarity.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Some authors have recently suggested that albumin could preserve the endothelial glycocalyx and help maintain vascular permeability.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Finally, albumin could be appropriate for fluid resuscitation in patients with cirrhosis or those undergoing liver<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> or cardiac surgery.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Recommendation 12</span><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend applying a restrictive volume replacement strategy to achieve target blood pressure until bleeding is controlled. (1B)</span></p><p id="par0230" class="elsevierStylePara elsevierViewall">It is reasonable to tolerate a certain degree of hypotension until bleeding has been controlled, taking into consideration the characteristics of each patient (advanced age, history of hypertension, and target tissue perfusion). Excessively high blood pressure can contribute to rebleeding.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">In liver surgery, a restrictive fluid strategy has been shown to reduce bleeding and transfusion requirement.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,19</span></a></p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Fluid resuscitation in hypotensive patients</span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Recommendation 13</span><p id="par0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend setting target systolic blood pressure between 80 and 90 mmHg in bleeding, hypotensive, trauma patients without head injury. This should only be maintained until the source of the bleeding has been controlled, particularly in elderly or hypertensive patients. (1C)</span></p><p id="par0245" class="elsevierStylePara elsevierViewall">“Damage control resuscitation”, in other words, restrictive fluid replacement and permissive hypotension, has proven to be beneficial.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,19,34,35</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">However, the recommended mean blood pressure (50−60 mmHg) and systolic blood pressure (80−90 mmHg) values are arbitrary and may not be safe in all trauma patients, particularly those with blunt and penetrating trauma,<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> and should be carefully considered in elderly<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> and chronically hypertensive<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> patients.</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Recommendation 14</span><p id="par0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In hypotensive patients with traumatic bleeding and TBI, we recommend setting a target systolic blood pressure of at least 110 mmHg until the source of bleeding has been controlled, particularly in certain patient groups, such as the elderly, hypertensive patients, etc. (1 C)</span></p><p id="par0260" class="elsevierStylePara elsevierViewall">Restrictive fluid replacement and permissive hypotension strategies are contraindicated in patients with severe TBI and acute spinal cord injury. In these cases, it is essential to maintain tissue perfusion pressure and cerebral autoregulation to ensure oxygenation.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,38</span></a></p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Recommendation 15</span><p id="par0265" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">If fluid therapy is not effective, we recommend considering early administration of norepinephrine to maintain blood pressure, ideally through a central venous line provided this does not delay the start of treatment. (1C)</span></p><p id="par0270" class="elsevierStylePara elsevierViewall">Vasopressors may be occasionally be necessary to maintain tissue perfusion, with norepinephrine being the agent of choice.</p><p id="par0275" class="elsevierStylePara elsevierViewall">A study comparing saline plus vasopressin versus saline alone found lower fluid requirements in the vasopressin group.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Although early vasopressors have been shown to be beneficial,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> observational studies have reported higher mortality among trauma patients receiving this therapy. For this reason, guidelines suggest using vasopressors in addition to fluids in patients with refractory hypotension.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,19</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">Norepinephrine is usually administered via a central venous line due to the risk of subcutaneous diffusion and necrosis, but peripheral venous administration is both feasible and effective.</p></span></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Damage control</span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Recommendation 16</span><p id="par0285" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend applying "damage control surgery" in trauma patients who require prolonged surgery and/or present acidosis and/or hypothermia and who also present complex or inaccessible anatomical lesions causing refractory bleeding. (1B)</span></p><p id="par0290" class="elsevierStylePara elsevierViewall">The aim of “damage control resuscitation” is to rapidly control bleeding and restore intravascular volume. The strategy includes minimising blood loss, hypotensive resuscitation, balanced haemostatic treatment with a high red blood cell:plasma:platelet ratio (1:1:1, according to the original concept),<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> the application of an MTP, restricted crystalloid infusion, and possibly haemostatic supplements.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,42,43</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">Damage control surgery is one of the basic resuscitation strategies in specific patients, and consists of abbreviated laparotomy and retroperitoneal packing to compress bleeding that is hard to control, followed by restoration of local blood flow where necessary and control of contamination from abdominal viscera.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This preliminary measure is followed at least 48 h later by a second intervention to remove the "packing", leaving the definitive abdominal repair for a third intervention, if necessary.</p><p id="par0300" class="elsevierStylePara elsevierViewall">The concept of “orthopaedic damage control”.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> consisting of initial stabilization of fractures and leaving definitive osteosynthesis for a second intervention, has been described in multiple trauma patients with severe bone fractures.</p></span></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Monitoring</span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Recommendation 17</span><p id="par0305" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend using dynamic variables such as stroke volume variation (SVV) and pulse pressure variation (PPV) instead of static variables such as central venous pressure (CVP) or pulmonary artery occluded pressure (PAOP) to guide fluid administration in patients in sinus rhythm with severe bleeding who are receiving controlled mechanical ventilation and do not respond to initial fluid therapy. (1B)</span></p><p id="par0310" class="elsevierStylePara elsevierViewall">Dynamic rather than static parameters should be used because they can measure preload and guide the response to fluids in patients with controlled mechanical ventilation and sinus heart rhythm. Commonly used dynamic variables with a high predictive value are stroke volume variation (SVV) and pulse pressure variation (PPV),<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> although dynamic variables of volume status (SVV and PPV), CO<span class="elsevierStyleInf">2</span> gap, and central venous oxygen saturation can also be used.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Recommendation 18</span><p id="par0315" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend performing early, serial determinations of lactate and base deficit to estimate and monitor the severity of bleeding, the degree of hypoperfusion, tissue hypoxia, and shock. (1B)</span></p><p id="par0320" class="elsevierStylePara elsevierViewall">Serial determination of early changes in serum lactate and base deficit are among the most useful laboratory data to estimate and monitor the extent of hypoperfusion and tissue hypoxia, and are a good indicator of prognosis in patients with MH.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,19</span></a></p></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Recommendation 19</span><p id="par0325" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In patients with severe bleeding, we recommend early monitoring of haemostasis in order to optimize the administration of blood products and prohaemostatic drugs. Treatment should be individualised using algorithms based, ideally, on the results of viscoelastic tests (1B), or failing that, on conventional clotting test results. (1C)</span></p><p id="par0330" class="elsevierStylePara elsevierViewall">The most widely used viscoelastic tests (VET) for monitoring coagulation are Rotem® (Instrumentation Laboratory, Bedford, MA, USA) and TEG® (Haemonetics Corporation, Boston, MA, USA). Conventional clotting tests should include prothrombin time (PT), activated partial thromboplastin time (aPTT), the Clauss fibrinogen assay, and platelet count. There is insufficient evidence to show the superiority of one method over another,<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42,45</span></a> but VETs provide rapid results and additional information on hyperfibrinolysis, clot firmness, and hypofibrinogenemia.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0335" class="elsevierStylePara elsevierViewall">In specific scenarios, such as cardiac surgery and liver transplantation, VETs have proven useful in reducing bleeding and transfusion needs (1B in cardiac surgery.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,46</span></a> The International Society of Thrombosis and Haemostasis (ISTH) suggests using VETs during liver transplantation<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> and the British Society of Haematology suggests using VETs to guide transfusion in obstetric haemorrhage, liver disease, cardiac surgery, and traumatic bleeding.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Recommendation 20</span><p id="par0340" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend basing the indication for RBC transfusion on the result of serial haemoglobin determinations, taking into account both clinical and laboratory parameters. (1C)</span></p><p id="par0345" class="elsevierStylePara elsevierViewall">The decision to administer blood should be based not only on clinical and laboratory parameters, such as blood pressure, heart rate, SI, plasma lactate levels, and base deficit, but also on the patient's clinical situation, i.e., multiple trauma (type of fracture or injury), surgery, or other scenarios.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48,49</span></a></p></span></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Blood transfusion</span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Recommendation 21</span><p id="par0350" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In patients presenting massive haemorrhage, we recommend considering early, restrictive transfusion of RBCs. (1B)</span></p><p id="par0355" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest using leukodepleted blood components. (2B)</span></p><p id="par0360" class="elsevierStylePara elsevierViewall">Transfusion of RBCs is generally necessary when blood loss is between 30% and 40%. Taking the patient’s specific situation into consideration, in addition to clinical and analytical parameters, will avoid performing transfusion based on isolated haemoglobin determinations. A restrictive strategy reduces the need for RBC transfusion, but does not have a greater impact on morbidity and mortality than a liberal strategy.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a></p><p id="par0365" class="elsevierStylePara elsevierViewall">The use of leukodepleted blood reduces the immune-related complications associated with allogeneic blood transfusion.</p></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Recommendation 22</span><p id="par0370" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend administering RBCs to achieve a target Hb of between 7 and 9 g/dL. (1B)</span></p><p id="par0375" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest considering a transfusion target of 9−10 g/dL in high-risk patients with comorbidities, such as chronic cardiovascular disease, acute coronary syndrome, stroke, thrombocytopaenia, and cancer. (2C)</span></p><p id="par0380" class="elsevierStylePara elsevierViewall">The restrictive transfusion threshold is usually 7−8 g/dL haemoglobin, and therefore should be avoided in most patients with haemoglobin above that range. In certain patient subgroups and clinical contexts, experts suggest achieving a plasma haemoglobin level of over 9 g/dL (chronic cardiovascular disease, acute coronary syndrome, stroke, or low-weight and elderly patients), although there is insufficient evidence to establish recommendations on the optimal transfusion strategy in these subgroups.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50,51</span></a></p></span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Recommendation 23</span><p id="par0385" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend basing initial empirical management of massive haemorrhage on the concept of haemostatic resuscitation with a high fresh plasma-to-packed red blood cell ratio (at least 1:2) in patients with massive haemorrhage secondary to severe trauma. There is insufficient evidence to make specific recommendations in non-trauma patient. (1C)</span></p><p id="par0390" class="elsevierStylePara elsevierViewall">Some authors suggest that transfusion strategies with fixed, high plasma/RBC ratios, are beneficial, particularly in multiple trauma patients, although it has not been possible to show that the 1:1:1 ratio has a better risk-benefit profile than the 1:1:2.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,52–54</span></a></p></span></span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Plasma transfusion</span><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Recommendation 24</span><p id="par0395" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In massive haemorrhage follow-up, we recommend administering fresh plasma using a goal-directed strategy based on clinical signs (microvascular bleeding, bleeding control) and laboratory tests (evidence of prolonged CT or R in viscoelastic tests, or a high prothrombin time (PT) ratio and/or activated partial thromboplastin time (aPTT) in conventional tests). (1C)</span></p><p id="par0400" class="elsevierStylePara elsevierViewall">Plasma transfusion is still the gold standard for preventing and treating coagulopathy in MH, despite its known drawbacks and the slow turnaround of laboratory tests.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0405" class="elsevierStylePara elsevierViewall">According to studies, transfusion based on a pre-established higher blood product ratio provides a higher volume of plasma and platelets compared with a goal-directed strategy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Platelet transfusion</span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Recommendation 25</span><p id="par0410" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend administering platelet concentrates to maintain platelets above 50 × 10<span class="elsevierStyleSup">9</span>/L in all patients with active bleeding. (1C)</span></p><p id="par0415" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest performing platelet transfusion to maintain platelets above 100 × 10<span class="elsevierStyleSup">9</span>/L in patients with massive haemorrhage and brain injury or eye injury, or in patients scheduled for neurosurgery or interventions involving the posterior pole of the eye, or in patients with platelets above 50 × 10<span class="elsevierStyleSup">9</span>/L and active, refractory bleeding. (2C)</span></p><p id="par0420" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest considering platelet concentrate transfusion to maintain a count of 50 × 10<span class="elsevierStyleSup">9</span>/L in patients requiring a major invasive procedure or in multiple trauma patients, even in the absence of bleeding. (2C)</span></p><p id="par0425" class="elsevierStylePara elsevierViewall">Despite the lack of solid scientific evidence, there is widespread agreement that a platelet count of at least 50 × 10<span class="elsevierStyleSup">9</span>/L should be maintained in patients with acute bleeding.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7,19,55–57</span></a></p><p id="par0430" class="elsevierStylePara elsevierViewall">In patients with TBI or eye bleeding, we recommend maintaining platelets above 100 × 10<span class="elsevierStyleSup">9</span>/L.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,19,56</span></a> This threshold has been extended to include patients with persistent bleeding.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,19,56,57</span></a> There are no strong recommendations regarding platelet transfusion to control bleeding in patients with platelet dysfunction.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a></p><p id="par0435" class="elsevierStylePara elsevierViewall">Some experts suggest administering prophylactic platelet transfusion in patients requiring major surgery or in multiple trauma patients when platelets are below 50 × 10<span class="elsevierStyleSup">9</span>/L.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,19,58,59</span></a></p></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Recommendation 26</span><p id="par0440" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest avoiding platelet transfusion in patients taking antiplatelet therapy before intracerebral haemorrhage (spontaneous or traumatic), unless they will require neurosurgery. (2C)</span></p><p id="par0445" class="elsevierStylePara elsevierViewall">This recommendation is derived from the PATCH study<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> in which clinical outcomes and 3-month mortality were worse in transfused patients (see recommendation 41).</p></span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Recommendation 27</span><p id="par0450" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest administering an initial dose of 4–8 platelet concentrates (or the equivalent: 1–2 units pooled), or 1 apheresis unit, adjusting the rate of administration to bleeding persistence, the platelet count achieved with the initial dose, the response to other measures to control bleeding, and the results of viscoelastic tests, if available. (2C)</span></p><p id="par0455" class="elsevierStylePara elsevierViewall">The platelet transfusion dose was already suggested in the previous version of this guide. If donors are available, 1 apheresis unit (equivalent to 4−6 platelet concentrates<span class="elsevierStyleItalic">)</span> increases the count by 30−50 × 10<span class="elsevierStyleSup">9</span>/L and reduces exposure to multiple donors.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,58,59</span></a></p></span></span><span id="sec0205" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Prothrombin complex concentrate</span><span id="sec0210" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Recommendation 28</span><p id="par0460" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In the context of massive haemorrhage, we recommend administering prothrombin complex concentrate and vitamin K to rapidly reverse the effect of antivitamin K oral anticoagulants in patients treated with these drugs. (1B)</span></p><p id="par0465" class="elsevierStylePara elsevierViewall">In this context, administration of prothrombin complex concentrate (PCC), preferably four-factor prothrombin complex concentrate,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,19,61–64</span></a> should be the first choice for urgent reversal of the anticoagulant effect of antivitamin-K drugs<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5,9,17</span></a> (Tables 4MS and 5MS, supplementary material). Although the optimal dosing strategy remains unclear, experts recommend adjusting the dose to the patient’s weight and INR values.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a></p></span><span id="sec0215" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">Recommendation 29</span><p id="par0470" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We do not recommend prothrombin complex concentrate as first choice haemostatic in patients with massive haemorrhage who have not received antivitamin K oral anticoagulants, although it may be used in certain patients based on the urgency of the treatment and the availability of fresh plasma. (1C)</span></p><p id="par0475" class="elsevierStylePara elsevierViewall">There is insufficient evidence to recommend the use of PCC as first choice haemostatic in MH.</p><p id="par0480" class="elsevierStylePara elsevierViewall">In specific scenarios, however, such as refractory bleeding, cardiac surgery,<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">63,64</span></a> liver surgery, and multiple trauma,<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> some experts suggest the off-label use of PCC in the context of multimodal management of MH, in accordance with the established legal framework.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5,9,17</span></a></p></span><span id="sec0220" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Recommendation 30</span><p id="par0485" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest restricting the use of activated prothrombin complex concentrate or rFVIIa to haemophiliac patients with inhibitors who present massive haemorrhage. (2C)</span></p><p id="par0490" class="elsevierStylePara elsevierViewall">Activated PCC (FEIBA) and rFVIIa are specifically indicated in congenital haemophilia with inhibitor and acquired haemophilia.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">66,67</span></a></p></span><span id="sec0225" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0245">Recommendation 31</span><p id="par0495" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest using prothrombin complex concentrates with caution in high thrombotic risk patients who present massive life-threatening bleeding or require surgery that cannot be delayed. (2C)</span></p><p id="par0500" class="elsevierStylePara elsevierViewall">Although PCCs are considered safe, thrombotic complications have been reported in 2%–4% of patients treated for MH. Therefore, the risk/benefit balance must be individualised in patients with bleeding and high risk for thrombosis.</p></span></span><span id="sec0230" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0250">Fibrinogen</span><span id="sec0235" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0255">Recommendation 32</span><p id="par0505" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend using the Clauss fibrinogen method, FIBTEM in ROTEM® or Functional Fibrinogen in TEG® to determine fibrinogen for diagnosis or clinical management decisions in patients with massive haemorrhage (1C)</span></p><p id="par0510" class="elsevierStylePara elsevierViewall">This recommendation, included in the previous version of the guide,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> remains valid.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,9,13,68</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a> Fibrinogen should be quantified using the Clauss method.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0240" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0260">Recommendation 33</span><p id="par0515" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In patients with active bleeding, we recommend administering fibrinogen concentrate if plasma levels (Clauss functional assay) are below 1.5–2.0 g/L, or A5 FIBTEM is below 7–9 mm or, by equivalence, the maximum amplitude on the citrated functional fibrinogen assay is less than 10 mm. (1C)</span></p><p id="par0520" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend administering fibrinogen concentrate together with RBCs in the initial phase of massive, particularly trauma-related, bleeding as an alternative to haemostatic resuscitation, even if VET or clotting results are unavailable (1C)</span></p><p id="par0525" class="elsevierStylePara elsevierViewall">The threshold for fibrinogen administration is controversial. Plasma levels should not be lower than 1.5 g/L,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,13,19</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45,68–70</span></a> which corresponds to A5 FIBTEM < 7 mm, although a threshold of 8−9 mm has been proposed in some clinical scenarios.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a> The equivalent threshold in TEG® is a maximum amplitude (MA<span class="elsevierStyleInf">CFF</span>) of 10 mm.</p></span></span><span id="sec0245" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0265">Recommendation 34</span><p id="par0530" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest administering an initial dose of 25−50 mg/kg of fibrinogen concentrate if the recommended plasma threshold is not achieved. Repeat doses, if required, should be guided by VET. (2C)</span></p><p id="par0535" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In adult traumatic bleeding patients, we suggest administering a minimum loading dose of 3−4 grams. (2C)</span></p><p id="par0540" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We do not recommend plasma as the first choice source of fibrinogen; however, it can be used if fibrinogen concentrate or cryoprecipitate is not available. (1C)</span></p><p id="par0545" class="elsevierStylePara elsevierViewall">Although we recommend administering a loading dose of 3−4 g in patients with multiple trauma and then continuing with VET-guided administration,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,19</span></a> the dose should ideally be weight-adjusted<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,19,68</span></a> (Table 6MS).</p><p id="par0550" class="elsevierStylePara elsevierViewall">Alternatively, 4−6 ml/kg cryoprecipitate could be used (approximately 1U/5−10 kg).<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,9,71</span></a></p></span><span id="sec0250" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0270">Factor VIIa</span><span id="sec0255" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0275">Recommendation 35</span><p id="par0555" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Factor VIIa should not be first-line therapy in massive haemorrhage. (1B)</span></p><p id="par0560" class="elsevierStylePara elsevierViewall">We suggest considering factor VIIa only in patients refractory to conventional haemostatic measures. (2B)</p><p id="par0565" class="elsevierStylePara elsevierViewall">Factor VIIa is not indicated for the treatment of MH. The few studies investigating factor VIIa in massive haemorrhage have reported equivocal results and a high incidence of thrombotic events, particularly arterial.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,9,17</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,72</span></a></p><p id="par0570" class="elsevierStylePara elsevierViewall">We suggest using factor VIIa only if all other haemostasis measures have been ineffective and fibrinogen, platelet count, pH, and temperature have been optimized<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,68,72</span></a> (Table 7MS).</p></span></span><span id="sec0260" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0280">Antifibrinolytics</span><span id="sec0265" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0285">Recommendation 36</span><p id="par0575" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend administering tranexamic acid (TXA) within 3 hours of the onset of massive traumatic haemorrhage and in patients with TBI. (1A)</span></p><p id="par0580" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest treating severe perioperative bleeding with tranexamic acid, ideally under VET guidance. (2B)</span></p><p id="par0585" class="elsevierStylePara elsevierViewall">The recommendation to use TXA in multiple trauma and TBI patients is based on the CRASH-2<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">73</span></a> and CRASH-3 studies, respectively. However, it is important to bear in mind that late administration does not provide benefits and increases complications.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">74</span></a> The recommended loading dose is 1 g over 10 min, followed by infusion of 1 g over 8 h.</p><p id="par0590" class="elsevierStylePara elsevierViewall">In the perioperative context, some authors suggest administering TXA to treat active bleeding, although this is not supported by evidence from randomised trials. TXA should be administered when hyperfibrinolysis has been confirmed, except in cardiac surgery, where there is a high level of evidence (1A) to recommend it as a prophylactic.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p></span></span><span id="sec0270" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0290">Other measures</span><span id="sec0275" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0295">Recommendation 37</span><p id="par0595" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest evaluating the administration of desmopressin (0.3 μg/kg) in bleeding patients with von Willebrand disease. (2C)</span></p><p id="par0600" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest evaluating the administration of desmopressin (0.3 μg/kg) in uraemic bleeding patients treated with aspirin or patients with critical bleeding and known platelet dysfunction. (2C)</span></p><p id="par0605" class="elsevierStylePara elsevierViewall">Desmopressin (DDAVP) is effective in the treatment and prevention of mild to moderate bleeding in patients with congenital or acquired disorders of primary haemostasis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,9</span></a></p></span><span id="sec0280" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0300">Recommendation 38</span><p id="par0610" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend using topical haemostatics in combination with conventional surgery-specific measures in patients presenting massive haemorrhage. (1B)</span></p><p id="par0615" class="elsevierStylePara elsevierViewall">Topical haemostatics are effective when the source of bleeding can be accessed directly.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7,9</span></a></p></span><span id="sec0285" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0305">Recommendation 39</span><p id="par0620" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend considering mechanical control measures, such as angioembolization. (1B)</span></p><p id="par0625" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest using endovascular procedures (e.g., REBOA) to treat massive haemorrhage in certain patients, if available. (2C)</span></p><p id="par0630" class="elsevierStylePara elsevierViewall">Angioembolization is an effective alternative to early open surgery<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in certain patients (nonvariceal or lower upper gastrointestinal bleeding, or pancreatitis-induced arterial bleeding), and in patients with pelvic fracture.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0635" class="elsevierStylePara elsevierViewall">The use of aortic balloon occlusion can be considered under extreme circumstances in multiple trauma patients to gain time until bleeding can be controlled,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> in patients with a ruptured abdominal aortic aneurysm, and in those with severe gastrointestinal or peripartum haemorrhage.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p></span><span id="sec0290" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0310">Recommendation 40</span><p id="par0640" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend monitoring plasma calcium levels in bleeding patients (1C), particularly if massive transfusion is required. (1B)</span></p><p id="par0645" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend maintaining plasma calcium levels in the normal range and administering calcium in case of hypocalcaemia (ionic Ca <3.6 mg/dl, or corrected serum calcium <7.5 mg/dl). (1B)</span></p><p id="par0650" class="elsevierStylePara elsevierViewall">It is important to control calcium whenever large volumes of blood components are administered.<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">75–77</span></a></p></span><span id="sec0295" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0315">Recommendation 41</span><p id="par0655" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In cases of severe or massive haemorrhage, we recommend ascertaining whether the patient is under treatment with antiplatelet drugs or anticoagulants. If so, reversal agents should be administered, provided an individual analysis has shown that the benefit outweighs the risk of thrombosis. (1B)</span></p><p id="par0660" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We recommend administering prothrombin complex concentrate plus vitamin-k in patients treated with vitamin K-dependent oral anticoagulants. (1B)</span></p><p id="par0665" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest performing early platelet transfusion in patients with bleeding clearly associated with antiplatelet drugs, ideally after monitoring platelet function. (2C)</span></p><p id="par0670" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In patients treated with dabigatran, we suggest administering idarucizumab instead of non-specific haemostatic agents such as prothrombin complex concentrates. (2A)</span></p><p id="par0675" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We suggest administering andexanet alpha or prothrombin complex concentrate in patients receiving oral factor-Xa inhibitors (“xabans”) who present life-threatening or uncontrolled bleeding. (2C)</span></p><p id="par0680" class="elsevierStylePara elsevierViewall">Platelets may be the best option in patients with bleeding clearly associated with antiplatelet drugs.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The effectiveness of this treatment will depend on certain factors, such as the antiplatelet drug involved, the time since the last dose, the mechanism and site of bleeding, and the criteria of efficacy.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">78</span></a> Dosage is equally uncertain, with some authors suggesting 0.7 × 10<span class="elsevierStyleSup">11</span>/10 kg (equivalent to approximately one unit of platelet concentrate per 10 kg, or 2 pools in a 70−80 kg patient) in bleeding associated with aspirin use, up to double when associated with clopidogrel, or even more in the case of prasugrel.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,78</span></a></p><p id="par0685" class="elsevierStylePara elsevierViewall">A systematic review of platelet transfusion in patients with brain haemorrhage was inconclusive due to methodological limitations of the studies reviewed.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58,79,80</span></a></p><p id="par0690" class="elsevierStylePara elsevierViewall">Specific reversal agents are recommended in patients treated with anticoagulant drugs<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> (Table 8MS). The use of idarucizumab to reverse dabigatran anticoagulation does not appear to be associated with a clear reduction in mortality.<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a> The recommended doses are 5 g in 2 intravenous doses of 2.5 g over 15 min. Andexanet-alpha has been approved to reverse anticoagulation in patients treated with apixaban and rivaroxaban.</p></span></span></span><span id="sec0300" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0320">Discussion</span><p id="par0695" class="elsevierStylePara elsevierViewall">Management of MH is extremely complex, and patient survival can be improved by using the multiple tools and strategies included in clinical guidelines, consensus documents, and massive transfusion protocols.</p><p id="par0700" class="elsevierStylePara elsevierViewall">This multidisciplinary document, endorsed by SEDAR, SEMICYUC and SETH, updates the recommendations of the original HEMOMAS document.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This version, like the previous edition, omits specific scenarios such as obstetrics, paediatrics, and gastrointestinal bleeding, because the specific measures required deviate from the purpose of this update.</p><p id="par0705" class="elsevierStylePara elsevierViewall">We used a methodology based on a review of relevant articles published since the previous edition — a strategy that allowed us to update the previous recommendations without amending the fundamental structure of the original document.</p><p id="par0710" class="elsevierStylePara elsevierViewall">The number of recommendations has been reduced to 41 – fewer than the 2016 edition – containing a total of 61 statements, of which 38 are recommendations and 23 suggestions. The only recommendations with the highest level of evidence refer to the early use of isotonic crystalloids and tranexamic acid in patients with traumatic MH. During the update process, we found it necessary to change the grade of recommendation or level of evidence and wording of certain statements. Table 2MS lists all these modifications.</p><p id="par0715" class="elsevierStylePara elsevierViewall">The document highlights the importance of damage control surgery, transfusion of blood products based on appropriate RBC/plasma/platelet ratios, guiding haemostatic therapy by VET or conventional coagulation tests that give a better picture of coagulopathy and allow clinicians to individualize treatment, and specific measures required in patients treated with antiplatelets and anticoagulants.</p></span><span id="sec0305" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0325">Conclusions</span><p id="par0720" class="elsevierStylePara elsevierViewall">MH is associated with a high rate of mortality. It is vital to regularly update recommendations for the multidisciplinary management of MH in order to allow clinicians to promptly diagnose patients with MH and at risk of MH, implement strategies to control bleeding, replace lost blood volume, and avoid the associated coagulopathy.</p></span><span id="sec0310" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0330">Financial support</span><p id="par0725" class="elsevierStylePara elsevierViewall">The present study has been funded by an unrestricted grant from CSL-Behring.</p></span><span id="sec0315" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0335">Acknowledgements</span><p id="par0735" class="elsevierStylePara elsevierViewall">The authors wish to thank Fernando Rico-Vilademoros for methodological support, Isabel San Andrés for the literature search, and Ampersand Consulting for logistics in preparing the manuscript. In the years since publication of the first document, some of the original authors have retired from their professional practice. Their generosity in giving way to other colleagues who have joined the panel of experts of the present document must be acknowledged. This new version would not have been possible without the publication of the first HEMOMAS document.</p></span><span id="sec0320" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0340">Author contributions</span><p id="par0785" class="elsevierStylePara elsevierViewall">JVL: general coordination, review of the recommendations, writing of the manuscript, review and approval of the manuscript. CA, EG, PM, PMN, PP. JAP, MQ, FJRM, AS: review of the recommendations, writing of the manuscript, review and approval of the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1967308" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1692684" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1967307" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1692685" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Recommendations and rationale" "secciones" => array:15 [ 0 => array:3 [ "identificador" => "sec0025" "titulo" => "Definition and evaluations" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Recommendation 1" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Recommendation 2" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Recommendation 3" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Recommendation 4" ] 4 => array:2 [ "identificador" => "sec0050" "titulo" => "Recommendation 5" ] ] ] 1 => array:3 [ "identificador" => "sec0055" "titulo" => "Temperature management" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Recommendation 6" ] ] ] 2 => array:3 [ "identificador" => "sec0065" "titulo" => "Fluid therapy" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Recommendation 7" ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Recommendation 8" ] 2 => array:2 [ "identificador" => "sec0080" "titulo" => "Recommendation 9" ] 3 => array:2 [ "identificador" => "sec0085" "titulo" => "Recommendation 10" ] 4 => array:2 [ "identificador" => "sec0090" "titulo" => "Recommendation 11" ] 5 => array:2 [ "identificador" => "sec0095" "titulo" => "Recommendation 12" ] ] ] 3 => array:3 [ "identificador" => "sec0100" "titulo" => "Fluid resuscitation in hypotensive patients" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0105" "titulo" => "Recommendation 13" ] 1 => array:2 [ "identificador" => "sec0110" "titulo" => "Recommendation 14" ] 2 => array:2 [ "identificador" => "sec0115" "titulo" => "Recommendation 15" ] ] ] 4 => array:3 [ "identificador" => "sec0120" "titulo" => "Damage control" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0125" "titulo" => "Recommendation 16" ] ] ] 5 => array:3 [ "identificador" => "sec0130" "titulo" => "Monitoring" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0135" "titulo" => "Recommendation 17" ] 1 => array:2 [ "identificador" => "sec0140" "titulo" => "Recommendation 18" ] 2 => array:2 [ "identificador" => "sec0145" "titulo" => "Recommendation 19" ] 3 => array:2 [ "identificador" => "sec0150" "titulo" => "Recommendation 20" ] ] ] 6 => array:3 [ "identificador" => "sec0155" "titulo" => "Blood transfusion" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0160" "titulo" => "Recommendation 21" ] 1 => array:2 [ "identificador" => "sec0165" "titulo" => "Recommendation 22" ] 2 => array:2 [ "identificador" => "sec0170" "titulo" => "Recommendation 23" ] ] ] 7 => array:3 [ "identificador" => "sec0175" "titulo" => "Plasma transfusion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0180" "titulo" => "Recommendation 24" ] ] ] 8 => array:3 [ "identificador" => "sec0185" "titulo" => "Platelet transfusion" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0190" "titulo" => "Recommendation 25" ] 1 => array:2 [ "identificador" => "sec0195" "titulo" => "Recommendation 26" ] 2 => array:2 [ "identificador" => "sec0200" "titulo" => "Recommendation 27" ] ] ] 9 => array:3 [ "identificador" => "sec0205" "titulo" => "Prothrombin complex concentrate" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0210" "titulo" => "Recommendation 28" ] 1 => array:2 [ "identificador" => "sec0215" "titulo" => "Recommendation 29" ] 2 => array:2 [ "identificador" => "sec0220" "titulo" => "Recommendation 30" ] 3 => array:2 [ "identificador" => "sec0225" "titulo" => "Recommendation 31" ] ] ] 10 => array:3 [ "identificador" => "sec0230" "titulo" => "Fibrinogen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0235" "titulo" => "Recommendation 32" ] 1 => array:2 [ "identificador" => "sec0240" "titulo" => "Recommendation 33" ] ] ] 11 => array:2 [ "identificador" => "sec0245" "titulo" => "Recommendation 34" ] 12 => array:3 [ "identificador" => "sec0250" "titulo" => "Factor VIIa" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0255" "titulo" => "Recommendation 35" ] ] ] 13 => array:3 [ "identificador" => "sec0260" "titulo" => "Antifibrinolytics" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0265" "titulo" => "Recommendation 36" ] ] ] 14 => array:3 [ "identificador" => "sec0270" "titulo" => "Other measures" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0275" "titulo" => "Recommendation 37" ] 1 => array:2 [ "identificador" => "sec0280" "titulo" => "Recommendation 38" ] 2 => array:2 [ "identificador" => "sec0285" "titulo" => "Recommendation 39" ] 3 => array:2 [ "identificador" => "sec0290" "titulo" => "Recommendation 40" ] 4 => array:2 [ "identificador" => "sec0295" "titulo" => "Recommendation 41" ] ] ] ] ] 8 => array:2 [ "identificador" => "sec0300" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0305" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0310" "titulo" => "Financial support" ] 11 => array:2 [ "identificador" => "sec0315" "titulo" => "Acknowledgements" ] 12 => array:2 [ "identificador" => "sec0320" "titulo" => "Author contributions" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-12" "fechaAceptado" => "2023-05-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1692684" "palabras" => array:6 [ 0 => "Massive haemorrhage" 1 => "Transfusion" 2 => "Red blood cells" 3 => "Fresh plasma" 4 => "Fibrinogen" 5 => "Viscoelastic assay" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1692685" "palabras" => array:6 [ 0 => "Hemorragia masiva" 1 => "Transfusión" 2 => "Concentrado de hematíes" 3 => "Plasma fresco" 4 => "Fibrinógeno" 5 => "Test viscoelásticos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This document is an update of the multidisciplinary document HEMOMAS, published in 2016 with the endorsement of the Spanish Scientific Societies of Anaesthesiology (SEDAR), Intensive Care (SEMICYUC) and Thrombosis and Haemostasis (SETH).</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The aim of this document was to review and update existing recommendations on the management of massive haemorrhage. The methodology of the update was based on several elements of the ADAPTE method by searching and adapting guidelines published in the specific field of massive bleeding since 2014, plus a literature search performed in PubMed and EMBASE from January 2014 to June 2021.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Based on the review of 9 guidelines and 207 selected articles, the 47 recommendations in the original article were reviewed, maintaining, deleting, or modifying each of them and the accompanying grades of recommendation and evidence. Following a consensus process, the final wording of the article and the resulting 41 recommendations were approved by all authors.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El presente documento supone una puesta al día del documento multidisciplinar HEMOMAS, publicado en el año 2016 con el aval de las Sociedades de Anestesiología y Reanimación (SEDAR), Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) y de Trombosis y Hemostasia (SETH).</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este documento fue revisar y actualizar las recomendaciones existentes sobre el manejo de la hemorragia masiva. Se siguió una metodología basada en elementos del método ADAPTE (búsqueda y adaptación de guías publicadas en el ámbito específico de la hemorragia masiva desde 2014, más búsqueda bibliográfica en PubMed y EMBASE desde enero-2014 hasta junio-2021). Tras la revisión de 9 guías y 207 artículos seleccionados, se actualizaron las 47 recomendaciones existentes en el artículo original, manteniendo, suprimiendo o modificando cada una de ellas y sus grados de recomendación y evidencia. Consensuadamente, los autores aprobaron la redacción final del artículo y las 41 recomendaciones resultantes.</p></span>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0795" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0330" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3905 "Ancho" => 2508 "Tamanyo" => 547948 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flowchart of bibliographic search.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(*) Manual search: identification of eligible article after reviewing the references included in selected articles and guidelines. (**) Articles cited in the recommendation rationale, without including citations in the introduction or methodology sections.</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 67058 ] ] 2 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc2.doc" "ficheroTamanyo" => 17558 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:81 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in hemorrhage control resuscitation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0000000000001093" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2022" "volumen" => "35" "paginaInicial" => "176" "paginaFinal" => "181" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2015.12" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2015" "volumen" => "313" "paginaInicial" => "471" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of severe perioperative bleeding: Guidelines from the European Society of Anaesthesiology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/EJA.0000000000000630" "Revista" => array:6 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2017" "volumen" => "34" "paginaInicial" => "332" "paginaFinal" => "395" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-019-2347-3" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2019" "volumen" => "23" "paginaInicial" => "98" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-021-06531-x" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2021" "volumen" => "47" "paginaInicial" => "1368" "paginaFinal" => "1392" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/trf.15161" "Revista" => array:7 [ "tituloSerie" => "Transfusion" "fecha" => "2019" "volumen" => "59" "numero" => "S2" "paginaInicial" => "1423" "paginaFinal" => "1428" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento multidisciplinar de consenso sobre el manejo de la hemorragia masiva (documento HEMOMAS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2015.05.002" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "483" "paginaFinal" => "504" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "The ADAPTE Collaboration. The ADAPTE Process Resource Toolkit for Guideline | Course Hero [Internet]. Available from: <a target="_blank" href="https://www.coursehero.com/file/p4k0kp8/The-ADAPTE-Collaboration-The-ADAPTE-Process-Resource-Toolkit-for-Guideline/">https://www.coursehero.com/file/p4k0kp8/The-ADAPTE-Collaboration-The-ADAPTE-Process-Resource-Toolkit-for-Guideline/</a>." ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Anesthesiology" "fecha" => "2015" "volumen" => "122" "paginaInicial" => "241" "paginaFinal" => "275" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initiation and termination of massive transfusion protocols: current strategies and future prospects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Anesth Analg" "fecha" => "2017" "volumen" => "125" "paginaInicial" => "2045" "paginaFinal" => "2055" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trauma patients at risk for massive transfusion: The role of scoring systems and the impact of early identification on patient outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Expert Rev Hematol" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "211" "paginaFinal" => "218" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional definition and characterisation of acute traumatic coagulopathy Europe PMC Funders Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3182281af5" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2011" "volumen" => "39" "paginaInicial" => "2652" "paginaFinal" => "2658" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of viscoelastic haemostatic assays in the management of major bleeding: A British Society for Haematology Guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.15524" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2018" "volumen" => "182" "paginaInicial" => "789" "paginaFinal" => "806" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic reviews of scores and predictors to trigger activation of massive transfusion protocols" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0000000000002372" "Revista" => array:6 [ "tituloSerie" => "J Trauma Acute Care Surg" "fecha" => "2019" "volumen" => "87" "paginaInicial" => "717" "paginaFinal" => "729" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Change of transfusion and treatment paradigm in major trauma patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.13920" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2017" "volumen" => "72" "paginaInicial" => "1317" "paginaFinal" => "1326" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Massive transfusion protocols: current best practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Clin Transfusi Med" "fecha" => "2016" "volumen" => "4" "paginaInicial" => "15" "paginaFinal" => "27" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Joint United Kingdom (UK) Blood Transfusion and Tissue. Transplantation Services Professional Advisory Committee. Transfusion management of major haemorrhage (Transfusion Handbook). [Internet]. [cited 2021 Nov 11]. Available from: <a target="_blank" href="https://www.transfusionguidelines.org/transfusion-handbook/7-effective-transfusion-in-surgery-and-critical-care/7-3-transfusion-management-of-major-haemorrhage">https://www.transfusionguidelines.org/transfusion-handbook/7-effective-transfusion-in-surgery-and-critical-care/7-3-transfusion-management-of-major-haemorrhage</a>." ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La aplicación de un protocolo de gestión para la hemorragia masiva reduce la mortalidad en pacientes con hemorragia no traumática: Resultados de la auditoría de un centro" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2016.05.003" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "550" "paginaFinal" => "559" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommandations sur la réanimation du choc hémorragique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Anesth Reanim" "fecha" => "2015" "volumen" => "1" "paginaInicial" => "62" "paginaFinal" => "74" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish Consensus Statement on alternatives to allogeneic blood transfusion: the 2013 update of the «Seville Document»" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Blood Transfus" "fecha" => "2013" "volumen" => "11" "paginaInicial" => "585" "paginaFinal" => "610" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Saline versus Plasma-Lyte A in initial resuscitation of trauma patients: a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e318295feba" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2014" "volumen" => "259" "paginaInicial" => "255" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-minimization analysis of two fluid products for resuscitation of critically injured trauma patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2146/ajhp130295" "Revista" => array:6 [ "tituloSerie" => "Am J Health Syst Pharm" "fecha" => "2014" "volumen" => "71" "paginaInicial" => "470" "paginaFinal" => "475" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: the BaSICS randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2021.11684" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2021" "volumen" => "326" "paginaInicial" => "1" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balanced crystalloids versus saline in critically ill patients: the PRISMA study of a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Med (Baltimore)" "fecha" => "2021" "volumen" => "100" "paginaInicial" => "e27203" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA Surg" "fecha" => "2013" "volumen" => "148" "paginaInicial" => "127" "paginaFinal" => "136" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of pre-hospital administration of lactated ringer’s solution versus normal saline in patients with traumatic brain injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurotrauma" "fecha" => "2016" "volumen" => "33" "paginaInicial" => "1054" "paginaFinal" => "1059" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2013.280502" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2013" "volumen" => "310" "paginaInicial" => "1809" "paginaFinal" => "1817" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colloids versus crystalloids for fluid resuscitation in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2013" "volumen" => "2013" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-021-06506-y" "Revista" => array:5 [ "tituloSerie" => "Intensive Care Med." "fecha" => "2021" "volumen" => "47" "paginaInicial" => "1181" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Saline or albumin for fluid resuscitation in patients with traumatic brain injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa067514" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2007" "volumen" => "357" "paginaInicial" => "874" "paginaFinal" => "884" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of albumin in the preservation of endothelial glycocalyx integrity and the microcirculation: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13613-020-00697-1" "Revista" => array:5 [ "tituloSerie" => "Ann Intensive Care" "fecha" => "2020" "volumen" => "10" "paginaInicial" => "85" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resuscitation fluids" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0000000000000551" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2018" "volumen" => "24" "paginaInicial" => "512" "paginaFinal" => "518" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "STS/SCA/AmSECT/SABM update to the clinical practice guidelines on patient blood management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2021.03.011" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2021" "volumen" => "35" "paginaInicial" => "2569" "paginaFinal" => "2591" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "10-Year trend in crystalloid resuscitation: reduced volume and lower mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijsu.2016.12.073" "Revista" => array:6 [ "tituloSerie" => "Int J Surg" "fecha" => "2017" "volumen" => "38" "paginaInicial" => "78" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: analysis of 1,030 consecutive trauma laparotomies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0000000000001273" "Revista" => array:6 [ "tituloSerie" => "J Trauma Acute Care Surg" "fecha" => "2017" "volumen" => "82" "paginaInicial" => "328" "paginaFinal" => "333" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005373-200206000-00020" "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "2002" "volumen" => "52" "paginaInicial" => "1141" "paginaFinal" => "1146" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preoperative fluid management in traumatic shock: a retrospective study for identifying optimal therapy of fluid resuscitation for aged patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MD.0000000000009966" "Revista" => array:5 [ "tituloSerie" => "Medicine" "fecha" => "2018" "volumen" => "97" "paginaInicial" => "e9966" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traditional systolic blood pressure targets underestimate hypotension-induced secondary brain injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0b013e31824af90b" "Revista" => array:6 [ "tituloSerie" => "J Trauma Acute Care Surg" "fecha" => "2012" "volumen" => "72" "paginaInicial" => "1135" "paginaFinal" => "1139" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of low-dose vasopressin on trauma outcome: prospective randomized study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "World J Surg" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "430" "paginaFinal" => "439" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasopressin, but not fluid resuscitation, enhances survival in a liver trauma model with uncontrolled and otherwise lethal hemorrhagic shock in pigs" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000542-200303000-00018" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2003" "volumen" => "98" "paginaInicial" => "699" "paginaFinal" => "704" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Damage control resuscitation in patients with severe traumatic hemorrhage: a practice management guideline from the Eastern Association for the Surgery of Trauma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0000000000001333" "Revista" => array:6 [ "tituloSerie" => "J Trauma Acute Care Surg" "fecha" => "2017" "volumen" => "82" "paginaInicial" => "605" "paginaFinal" => "617" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemostatic defects in massive transfusion: an update and treatment recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/17474086.2021.1858788" "Revista" => array:6 [ "tituloSerie" => "Expert Rev Hematol" "fecha" => "2021" "volumen" => "14" "paginaInicial" => "219" "paginaFinal" => "239" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic accuracy of massive transfusion, critical administration threshold, and resuscitation intensity in assessing mortality in traumatic patients with severe hemorrhage: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3346/jkms.2019.34.e318" "Revista" => array:5 [ "tituloSerie" => "J Korean Med Sci" "fecha" => "2019" "volumen" => "34" "paginaInicial" => "e318" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005373-200004000-00006" "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "2000" "volumen" => "48" "paginaInicial" => "613" "paginaFinal" => "623" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-020-06266-1" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2021" "volumen" => "47" "paginaInicial" => "49" "paginaFinal" => "59" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Society of Thoracic Surgeons General Thoracic Surgery Database: 2021 update on outcomes and research" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2021.06.024" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2021" "volumen" => "112" "paginaInicial" => "693" "paginaFinal" => "700" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The utility of viscoelastic methods in the prevention and treatment of bleeding and hospital-associated venous thromboembolism in perioperative care: guidance from the SSC of the ISTH" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.14265" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2018" "volumen" => "16" "paginaInicial" => "2336" "paginaFinal" => "2340" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early packed red blood cell transfusion in major trauma patients: evaluation and comparison of different prediction scores for massive transfusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/vox.13171" "Revista" => array:6 [ "tituloSerie" => "Vox Sang" "fecha" => "2022" "volumen" => "117" "paginaInicial" => "227" "paginaFinal" => "234" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severity of post-partum hemorrhage after vaginal delivery is not predictable from clinical variables available at the time post-partum hemorrhage is diagnosed" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jog.12528" "Revista" => array:6 [ "tituloSerie" => "J Obstet Gynaecol Res" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "199" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0250" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transfusion thresholds for guiding red blood cell transfusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2021" "volumen" => "12" ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0255" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A guideline for the haematological management of major haemorrhage: a British Society for Haematology Guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Haematol" "fecha" => "2022" "volumen" => "198" "paginaInicial" => "654" "paginaFinal" => "667" ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0260" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimal dose, timing and ratio of blood products in massive transfusion: results from a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.tmrv.2017.06.003" "Revista" => array:6 [ "tituloSerie" => "Transfus Med Rev" "fecha" => "2018" "volumen" => "32" "paginaInicial" => "6" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0265" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Should all massively transfused patients be treated equally? An analysis of massive transfusion ratios in the nontrauma setting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Crit Care Med" "fecha" => "2017" "volumen" => "45" "paginaInicial" => "1311" "paginaFinal" => "1316" ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0270" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between ratio of fresh frozen plasma to red blood cells during massive transfusion and survival among patients without traumatic injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamasurg.2017.0098" "Revista" => array:6 [ "tituloSerie" => "JAMA Surg" "fecha" => "2017" "volumen" => "152" "paginaInicial" => "574" "paginaFinal" => "580" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0275" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implementation of massive transfusion protocols in the United States: the relationship between evidence and practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000001731" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2017" "volumen" => "124" "paginaInicial" => "9" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0280" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet transfusion: an update on indications and guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cll.2021.07.005" "Revista" => array:6 [ "tituloSerie" => "Clin Lab Med" "fecha" => "2021" "volumen" => "41" "paginaInicial" => "621" "paginaFinal" => "634" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0285" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet transfusion: and update on challenges and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/JBM.S234374" "Revista" => array:6 [ "tituloSerie" => "J Blood Med" "fecha" => "2020" "volumen" => "11" "paginaInicial" => "19" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0290" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the use of platelet transfusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.14423" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2017" "volumen" => "176" "paginaInicial" => "365" "paginaFinal" => "394" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0295" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet transfusion: a clinical practice guideline from the AABB" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/M14-1589" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2015" "volumen" => "162" "paginaInicial" => "205" "paginaFinal" => "213" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0300" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2016" "volumen" => "387" "numero" => "10038" "paginaInicial" => "2605" "paginaFinal" => "2613" ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0305" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A European consensus statement on the use of four-factor prothrombin complex concentrate for cardiac and non-cardiac surgical patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.15181" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2021" "volumen" => "76" "paginaInicial" => "381" "paginaFinal" => "392" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0310" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Roles of four-factor prothrombin complex concentrate in the management of critical bleeding" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.tmrv.2021.06.007" "Revista" => array:6 [ "tituloSerie" => "Transfus Med Rev" "fecha" => "2021" "volumen" => "35" "paginaInicial" => "96" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0315" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utility of 4-factor prothrombin complex concentrate in trauma and acute-care surgical patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7556/jaoa.2018.171" "Revista" => array:6 [ "tituloSerie" => "J Am Osteopath Assoc" "fecha" => "2018" "volumen" => "118" "paginaInicial" => "789" "paginaFinal" => "797" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0320" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of prothrombin complex concentrate for the treatment of bleeding: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.14991" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2020" "volumen" => "18" "paginaInicial" => "2457" "paginaFinal" => "2467" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0325" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2352-3026(17)30077-7" "Revista" => array:6 [ "tituloSerie" => "Lancet Haematol" "fecha" => "2017" "volumen" => "4" "paginaInicial" => "e258" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0330" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish Consensus Guidelines on prophylaxis with bypassing agents in patients with haemophilia and inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1160/TH15-07-0568" "Revista" => array:6 [ "tituloSerie" => "Thromb Haemost" "fecha" => "2016" "volumen" => "115" "paginaInicial" => "872" "paginaFinal" => "895" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0335" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuous infusion of recombinant activated factor VII: a review of data in congenital hemophilia with inhibitors and congenital factor VII deficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/JBM.S184040" "Revista" => array:6 [ "tituloSerie" => "J Blood Med" "fecha" => "2018" "volumen" => "9" "paginaInicial" => "227" "paginaFinal" => "239" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0340" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of factor concentrates for the management of perioperative bleeding: guidance from the SSC of the ISTH" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jth.13893" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2018" "volumen" => "16" "paginaInicial" => "170" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0345" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current perspective on fibrinogen concentrate in critical bleeding" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/17512433.2020.1776608" "Revista" => array:6 [ "tituloSerie" => "Expert Rev Clin Pharmacol" "fecha" => "2020" "volumen" => "13" "paginaInicial" => "761" "paginaFinal" => "778" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0350" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4097/kja.19169" "Revista" => array:5 [ "tituloSerie" => "Korean J Anesthesiol" "fecha" => "2019" "volumen" => "72" "paginaInicial" => "297" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib0355" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Which is the preferred blood product for fibrinogen replacement in the bleeding patient with acquired hypofibrinogenemia-cryoprecipitate or fibrinogen concentrate?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Transfusion" "fecha" => "2020" "volumen" => "60" "numero" => "Suppl 3" "paginaInicial" => "S17" "paginaFinal" => "S23" ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib0360" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduced mortality by meeting guideline criteria before using recombinant activated factor VII in severe trauma patients with massive bleeding" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aew276" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2016" "volumen" => "117" "paginaInicial" => "470" "paginaFinal" => "476" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 72 => array:3 [ "identificador" => "bib0365" "etiqueta" => "73" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(10)60835-5" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2010" "volumen" => "376" "paginaInicial" => "23" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 73 => array:3 [ "identificador" => "bib0370" "etiqueta" => "74" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(19)32233-0" "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "2019" "volumen" => "394" "numero" => "10210" "paginaInicial" => "1713" "paginaFinal" => "1723" "link" => array:1 [ …1] ] ] ] ] ] ] 74 => array:3 [ "identificador" => "bib0375" "etiqueta" => "75" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemia in trauma patients receiving massive transfusion" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jss.2015.12.036" "Revista" => array:6 [ "tituloSerie" => "J Surg Res" "fecha" => "2016" "volumen" => "202" "paginaInicial" => "182" "paginaFinal" => "187" "link" => array:1 [ …1] ] ] ] ] ] ] 75 => array:3 [ "identificador" => "bib0380" "etiqueta" => "76" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Massive transfusions and severe hypocalcemia: an opportunity for monitoring and supplementation guidelines" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Transfusion (Paris)" "fecha" => "2021" "volumen" => "61" "numero" => "Suppl 1(S1)" "paginaInicial" => "S188" "paginaFinal" => "94" ] ] ] ] ] ] 76 => array:3 [ "identificador" => "bib0385" "etiqueta" => "77" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between ionized calcium concentrations during hemostatic transfusion and calcium treatment with mortality in major trauma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000005431" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg." "fecha" => "2021" "volumen" => "132" "paginaInicial" => "1684" "paginaFinal" => "1691" "link" => array:1 [ …1] ] ] ] ] ] ] 77 => array:3 [ "identificador" => "bib0390" "etiqueta" => "78" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of bleeding events associated with antiplatelet therapy: evidence, uncertainties and pitfalls" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Med" "fecha" => "2020" "volumen" => "9" "paginaInicial" => "1" "paginaFinal" => "11" ] ] ] ] ] ] 78 => array:3 [ "identificador" => "bib0395" "etiqueta" => "79" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of platelet transfusion on intracerebral hemorrhage in patients on antiplatelet therapy—an analysis based on intracerebral hemorrhage score" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.wneu.2018.01.006" "Revista" => array:6 [ "tituloSerie" => "World Neurosurg" "fecha" => "2018" "volumen" => "111" "paginaInicial" => "e895" "paginaFinal" => "904" "link" => array:1 [ …1] ] ] ] ] ] ] 79 => array:3 [ "identificador" => "bib0400" "etiqueta" => "80" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiplatelet agent reversal is unnecessary in blunt traumatic brain injury patients not requiring immediate craniotomy" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Surg" "fecha" => "2020" "volumen" => "86" "paginaInicial" => "826" "paginaFinal" => "829" ] ] ] ] ] ] 80 => array:3 [ "identificador" => "bib0405" "etiqueta" => "81" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct oral anticoagulants: a review on the current role and scope of reversal agents" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11239-019-01954-2" "Revista" => array:6 [ "tituloSerie" => "J Thromb Thrombolysis" "fecha" => "2020" "volumen" => "49" "paginaInicial" => "271" "paginaFinal" => "286" "link" => array:1 [ …1] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000007000000007/v1_202309151027/S2341192923001257/v1_202309151027/en/main.assets" "Apartado" => array:4 [ "identificador" => "47200" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000007000000007/v1_202309151027/S2341192923001257/v1_202309151027/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001257?idApp=UINPBA00004N" ]
