Ep 206 Massive Hemorrhage Protocols 2.0 – Update on the 7 Ts
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Aug 4, 2025 
Dr. Jeannie Callum, a transfusion hematologist, and Dr. Andrew Petrosoniak, a specialist in high-performance resuscitation teams, discuss cutting-edge strategies for managing massive hemorrhage. They delve into alternatives to fresh frozen plasma when it’s unavailable and the significance of fibrinogen testing. The pair also emphasize the importance of tailored approaches for different patient scenarios, including trauma and obstetrical cases, while highlighting the critical role of teamwork in effective hemorrhage management.
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Prevent Hypothermia in Bleeding
- Monitor and actively prevent hypothermia in bleeding patients to preserve coagulation.
- Provide warming from pre-hospital phase through trauma bay to OR to reduce transfusion needs.
Lab Targets for Transfusion
- Target hemoglobin of 70 to 90 once bleeding controlled; higher targets waste blood without outcome benefits.
- Maintain fibrinogen above 1.5-2 g/L, platelets above 50k (or 100k for head injury), and INR below 1.8.
When to Stop MHP
- Regularly reassess need for ongoing MHP every 30 minutes during resuscitation.
- Collaborate with blood bank technicians on protocol termination after one hour without transfusions.