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Contemporary management of major haemorrhage in critical care

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A Correction to this article was published on 29 January 2024

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Abstract

Haemorrhagic shock is frequent in critical care settings and responsible for a high mortality rate due to multiple organ dysfunction and coagulopathy. The management of critically ill patients with bleeding and shock is complex, and treatment of these patients must be rapid and definitive. The administration of large volumes of blood components leads to major physiological alterations which must be mitigated during and after bleeding. Early recognition of bleeding and coagulopathy, understanding the underlying pathophysiology related to specific disease states, and the development of individualised management protocols are important for optimal outcomes. This review describes the contemporary understanding of the pathophysiology of various types of coagulopathic bleeding; the diagnosis and management of critically ill bleeding patients, including major haemorrhage protocols and post-transfusion management; and finally highlights recent areas of opportunity to better understand optimal management strategies for managing bleeding in the intensive care unit (ICU).

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, USA

    Cheryl L. Maier

  2. Centre for Trauma Sciences, Queen Mary University of London, London, UK

    Karim Brohi

  3. Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Nicola Curry

  4. Nuffield Department of Clinical and Laboratory Sciences, Radcliffe Department of Medicine, Oxford University, Oxford, UK

    Nicola Curry

  5. Department of Intensive Care and Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands

    Nicole P. Juffermans

  6. Department of Anaesthesiology, Intensive Care and Pain Clinic, Vall d’Hebron Trauma, Rehabilitation and Burns Hospital, Autonomous University of Barcelona, Passeig de La Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Lidia Mora Miquel

  7. Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, PA, USA

    Matthew D. Neal

  8. Department of Pathology, Duke University School of Medicine, Durham, NC, USA

    Beth H. Shaz

  9. Amsterdam University Medical Centers, Amsterdam, The Netherlands

    Alexander P. J. Vlaar

  10. Service de Médecine Intensive-Réanimation, Department of Intensive Care, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), 1, Place de L’Hôpital, 67091, Strasbourg Cedex, France

    Julie Helms

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  1. Cheryl L. Maier
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  2. Karim Brohi
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Corresponding author

Correspondence to Julie Helms.

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Conflicts of interest

CLM has nothing to disclose. KB has received grants from Werfen GmbH Ltd. NC has received study grants from national agencies: DSTL, Welcome Trust, MRC, and Investigator led grants from commercial companies: CSL Behring, SOBI. She has received honoraria for lectures from the Limbic and support for attending meetings from LFB, CSL Behring and SOBI. NC participates on an Advisory Board from Octapharma. NPJ has nothing to disclose. LMM has received honoraria for lectures from Octapharma, Ferrer Hospital (Haemonetics) and Werfen. She has received support for attending meetings and/or travel from ESAIC and Croatian Society of Anesthesiology. MDN has received grants from National Institutes of Health, National Institute of General Medical Services, Haemonetics, Alexion and Instrumentation Laboratories, honoraria for lectures from Haemonetics and Takeda, payment for expert testimony from Romanucci Blandon Law and Matis Baum O’Connor, support for attending meetings and/or travel from Takeda; participates on a Data Safety Monitoring Board or Advisory Board from NHLBI CONNECTS Steering Committee; is the Chief Medical Officer, Haima Therapeutics, and has Patents planned, issued or pending (US Patent 11,408.844; US Patent 9.072,760). BS has received book royalties from Elsevier, consulting fees from Chilled Platelets Study and supporting fees for attending meetings from Biomedical Excellence for Safer Transfusion. APJV has nothing to disclose. JH has received honoraria for lectures from Asahi Kasei, Diagnostica Stago, Pfizer PFE and Sanofi Aventis France.

Ethical disclosure

This study has been authorised by ethical committee (Comité de Protection des Personnes Nord Ouest IV 2018-A03446-49).

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Maier, C.L., Brohi, K., Curry, N. et al. Contemporary management of major haemorrhage in critical care. Intensive Care Med 50, 319–331 (2024). https://doi.org/10.1007/s00134-023-07303-5

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