{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:52:23Z","timestamp":1792194743360,"version":"4.4.0"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,1,28]],"date-time":"2024-01-28T00:00:00Z","timestamp":1706400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015675","name":"National Blood Authority","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015675","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2024,3,4]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n \n The management of patients with critical bleeding requires a multidisciplinary approach to achieve haemostasis, optimise physiology, and guide blood component use. The 2011\n Patient blood management guidelines: module 1 \u2014 critical bleeding\/massive transfusion<\/jats:italic>\n were updated and published. Systematic reviews were conducted for pre\u2010specified research questions, and recommendations were based on meta\u2010analyses of included studies.\n <\/jats:p>\n <\/jats:sec>\n \n Main recommendations<\/jats:title>\n \n The critical bleeding\/massive transfusion guideline includes seven recommendations and 11 good practice statements addressing:\n \n \n major haemorrhage protocols (MHPs) facilitating a multidisciplinary approach to haemorrhage control, correction of coagulopathy and normalisation of physiological derangement;<\/jats:p>\n <\/jats:list-item>\n \n measurement of physiological, biochemical and metabolic parameters in critical bleeding\/massive transfusion;<\/jats:p>\n <\/jats:list-item>\n \n the optimal ratio of red blood cells to other blood components;<\/jats:p>\n <\/jats:list-item>\n \n the use of tranexamic acid;<\/jats:p>\n <\/jats:list-item>\n \n viscoelastic haemostatic assays; and<\/jats:p>\n <\/jats:list-item>\n \n cell salvage.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Changes in management as a result of the guideline<\/jats:title>\n The new guideline recommends MHPs be established as standard of care in all institutions managing patients with critical bleeding. In addition to routine physiological markers, the new guideline recommends temperature, biochemistry and coagulation profiles be measured early and frequently, providing parameters that define critical derangements. Ratio\u2010based MHPs should include no fewer than four units of fresh frozen plasma and one adult unit of platelets for every eight units of red blood cells. In the setting of trauma and obstetric haemorrhage, administration of tranexamic acid within three hours of bleeding onset is recommended. The use of recombinant activated factor VII (rFVIIa) is not recommended. There was insufficient evidence to make recommendations on the use of viscoelastic haemostatic assays or cell salvage as part of MHPs.<\/jats:p>\n <\/jats:sec>","DOI":"10.5694\/mja2.52212","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T00:53:38Z","timestamp":1706489618000},"page":"211-216","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Patient blood management guideline for adults with critical bleeding"],"prefix":"10.5694","volume":"220","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0508-2450","authenticated-orcid":false,"given":"Biswadev","family":"Mitra","sequence":"first","affiliation":[{"name":"Emergency and Trauma Centre, Alfred Health Melbourne VIC"},{"name":"Monash University Melbourne VIC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Jorgensen","sequence":"additional","affiliation":[{"name":"Health Technology Analysts Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1570-0707","authenticated-orcid":false,"given":"Michael C","family":"Reade","sequence":"additional","affiliation":[{"name":"Joint Health Command, Australian Defence Force Canberra ACT"},{"name":"Royal Brisbane and Women's Hospital Brisbane QLD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastazia","family":"Keegan","sequence":"additional","affiliation":[{"name":"PathWest Laboratory Medicine King Edward Memorial Hospital Perth WA"},{"name":"Australia Red Cross Lifeblood Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Holley","sequence":"additional","affiliation":[{"name":"Joint Health Command, Australian Defence Force Canberra ACT"},{"name":"Royal Brisbane and Women's Hospital Brisbane QLD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Farmer","sequence":"additional","affiliation":[{"name":"University of Western Australia Perth WA"},{"name":"Royal Perth Hospital Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nichole","family":"Harvey","sequence":"additional","affiliation":[{"name":"James Cook University Townsville QLD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Winearls","sequence":"additional","affiliation":[{"name":"Monash University Melbourne VIC"},{"name":"Gold Coast University Hospital Gold Coast QLD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Parr","sequence":"additional","affiliation":[{"name":"Liverpool Hospital Sydney NSW"},{"name":"University of New South Wales Sydney NSW"},{"name":"Macquarie University Hospital Sydney NSW"},{"name":"Macquarie University Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig J","family":"French","sequence":"additional","affiliation":[{"name":"Western Health Melbourne VIC"},{"name":"University of Melbourne Melbourne VIC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Clinical and Consumer Reference group for the update of Patient Blood Management Guidelines (Module 1: Critical Bleeding\/Massive Transfusion)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,28]]},"reference":[{"key":"e_1_2_10_1_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32203-7"},{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31678-6"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/vox.12487"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.14006"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEJ.0b013e328342310e"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/vox.12121"},{"key":"e_1_2_10_7_1","unstructured":"National Blood Authority.Patient blood management guideline for adults with critical bleeding.https:\/\/blood.gov.au\/best\u2010practice\/patient\u2010blood\u2010management\/pbm\u2010guidelines\/patient\u2010blood\u2010management\u2010guideline\u2010adults(viewed July 2023)."},{"key":"e_1_2_10_8_1","volume-title":"Guidelines for guidelines handbook","author":"National Health and Medical Research Council","year":"2016"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090449"},{"key":"e_1_2_10_10_1","unstructured":"HigginsJ ThomasJ ChandlerJ et\u00a0al.Cochrane handbook for systematic reviews of interventions version 6.3. 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