Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 31: Massive Transfusion with Dr. Stephen Freiberg
Feb 2, 2017
Dr. Stephen Freiberg, a chief resident, discusses the highlights of massive transfusion in anesthesia settings, covering when and how to do it, complications, and management strategies. The podcast addresses issues like hyperkalemia, hypocalcemia, hypothermia, coagulopathy in trauma patients, and transfusion-associated circulatory overload (TACO). It emphasizes the importance of standardized protocols, early initiation of transfusion, and implementing massive transfusion protocols in trauma resuscitation.
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Replace Calcium Proactively
- Give calcium routinely during massive transfusion because citrate chelates ionized calcium.
- Administer ~500–1000 mg calcium gluconate (or 250–500 mg calcium chloride) per 500 mL product, roughly one dose per two products.
Actively Prevent Hypothermia
- Prevent hypothermia by using blood warmers, forced-air warming, and increasing room temperature.
- Maintain normothermia because hypothermia worsens coagulopathy and arrhythmia risk.
Coagulopathy Is Multifactorial
- Trauma coagulopathy is multifactorial: dilution, tissue injury, and fibrinolysis combine to impair clotting.
- Quantitative labs lag and don't measure function, so functional viscoelastic testing adds timely, actionable data.