Statements for which consensus was not achieved
| Domain; statement | Rationale |
|---|---|
| 4. Types of blood components and products | |
| 4.6 In suspected or confirmed hemorrhagic shock secondary to trauma, balanced transfusion with plasma, RBCs and platelets in a ratio of 1:1:1–1:1:2 is ideal. As hospital major hemorrhage protocols usually lead with RBCs, prehospital providers should consider prioritizing plasma transfusion, as well as communicating the need for early transfusion of plasma and platelets to the receiving hospital, to achieve a balanced transfusion over the patient’s journey. | The panel considered there to be insufficient evidence to make strong recommendations on balanced transfusion and the use of plasma in the prehospital and retrieval setting. Although there was general agreement that a balanced transfusion approach, as outlined in the Ontario consensus document on in-hospital major hemorrhage protocols, (14) is likely beneficial, the panel agreed that an attempt to standardize such an approach in the prehospital and retrieval setting was beyond the scope of this document. The panel considered the results of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial (65) to show no difference in outcomes between a ratio of RBCs to plasma of 1:1 and 2:1. |
| 7. Resuscitation targets to halt ongoing transfusion | |
| 7.3 Crystalloids and vasopressor/inotrope infusions should be used to treat hemorrhagic shock only if there is diagnosed or suspected concurrent cardiac impairment or neurogenic shock, or in a peri-arrest situation, or where blood components and products are not available or have been depleted. | Similar to the rationale for statement 4.6, the panel largely agreed with the clinical arguments supporting this statement (62) but considered it to be beyond the scope of this document. |
Note: RBC = red blood cell.