Priority 4 from the Blood Transfusion and Blood Donation PSP

UNCERTAINTY: What is the optimal type and combination of blood products [red blood cells, platelets, frozen plasma] for adult patients* with a major haemorrhage that requires a transfusion of 4 or more units of blood]? *Aged over 16 years old. (JLA PSP Priority 4)
Overall ranking	4
JLA question ID	0063/4
Explanatory note	Not available for this PSP
Evidence	1. Yu F, Zhong T, Wu G. [Efficacy of high versus low plasma: red blood cell ratio resuscitation in patients with severe trauma requiring massive blood transfusion: a meta-analysis]. Nan Fang Yi Ke Da Xue Xue Bao = Journal of Southern Medical University. 2017;37(-1):119-23. 2. Wikkelso A, Wetterslev J, Moller AM, Afshari A. Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to monitor haemostatic treatment in bleeding patients: a systematic review with meta-analysis and trial sequential analysis. Anaesthesia. 2017. Apr;72(4):519-531. doi: 10.1111/anae.13765 3. Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: a practice management guideline from the Eastern Association for the Surgery of Trauma. The Journal of Trauma and Acute Care Surgery. 2017;82(-3):605-17. 4. Fahrendorff M, Oliveri RS, Johansson PI. The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products - a systematic review and meta-analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2017;25(-1):39-. 5. Deppe AC, Weber C, Zimmermann J, Kuhn EW, Slottosch I, Liakopoulos OJ, et al. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. The Journal of Surgical Research. 2016;203(-2):424-33. 6. Wikkelso A, Wetterslev J, Moller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. The Cochrane Database of Systematic Reviews. 2016(-8):CD007871-CD. 7. Jones AR, Frazier SK. Association of blood component ratio with clinical outcomes in patients after trauma and massive transfusion: a systematic review. Advanced Emergency Nursing Journal. 2016;38(-2):157-68. 8. Jiang LB, Zhang M, Jiang SY, Ma YF. Early goal-directed resuscitation for patients with severe sepsis and septic shock: a meta-analysis and trial sequential analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2016;24(-1):23-. 9. Boutin A, Chasse M, Shemilt M, Lauzier F, Moore L, Zarychanski R, et al. Red blood cell transfusion in patients with traumatic brain injury: a systematic review and meta-analysis. Transfusion Medicine Reviews. 2016;30(-1):15-24. 10. McQuilten ZK, Crighton G, Engelbrecht S, Gotmaker R, Brunskill SJ, Murphy MF, et al. Transfusion interventions in critical bleeding requiring massive transfusion: a systematic review. Transfusion Medicine Reviews. 2015;29(-2):127-37. 11. Balvers K, Wirtz MR, van Dieren S, Goslings JC, Juffermans NP. Risk factors for trauma-induced coagulopathy and transfusion-associated multiple organ failure in severely injured trauma patients. Frontiers in Medicine. 2015.
Health Research Classification System category	Generic Health Relevance

Extra information provided by this PSP
Original uncertainty examples	Are major haemorrhage protocols optimised for different age groups e.g. elderly? ~ How can we clarify and improve the guidance on massive haemorrhage? ~ In major haemorrhage settings for example trauma, is there any information how older or younger patients respond to generic major haemorrhage protocols? ~ Improved protocols for massive haemorrhages in the critical care unit ~ Wider knowledge of best way to manage brisk haemorrhage i.e. ratio of blood:FFP:platelets
Submitted by	1 blood recipient ~ 3 relatives or carers of blood recipients ~ 7 blood donors ~ 18 health professionals ~ 2 unknown

Extra information provided by this PSP

Original uncertainty examples

Are major haemorrhage protocols optimised for different age groups e.g. elderly? ~ How can we clarify and improve the guidance on massive haemorrhage? ~ In major haemorrhage settings for example trauma, is there any information how older or younger patients respond to generic major haemorrhage protocols? ~ Improved protocols for massive haemorrhages in the critical care unit ~ Wider knowledge of best way to manage brisk haemorrhage i.e. ratio of blood:FFP:platelets

Submitted by

1 blood recipient ~ 3 relatives or carers of blood recipients ~ 7 blood donors ~ 18 health professionals ~ 2 unknown

PSP information
PSP unique ID	0063
PSP name	Blood Transfusion and Blood Donation
Total number of uncertainties identified by this PSP.	51 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	28 February 2018