Queensland Health
Massive haemorrhage protocol (MHP)
MHP activation criteria
Continue resuscitation Actively bleeding and any of:
• Give tranexamic acid • 4 units RBC in < 4 hours plus haemodynamic instability
1g IV over 10 minutes
• Estimated blood loss of > 2.5 L
(if not already given)
• Clinical or laboratory signs of coagulopathy
• Refer to flowchart: Initial
response to PPH OR in lower resource settings as per local protocol
Optimise
• Oxygenation Lead clinician activates MHP
• Cardiac output • Notify usual/nearest laboratory/blood bank
• Tissue perfusion • Identify time frame for product delivery
• Temperature (actively • Inform lab if using ROTEM® or TEG®
warm woman and fluid) • Contact haematologist/request other assistance
• Metabolic state • Contact RSQ 1300 799 127 early (as relevant to service) and
plan definitive care
http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au
Targets
• Temperature > 35° C
• pH > 7.2 Yes ROTEM® No
• Base excess minus 6 to
or
positive 6
• Lactate < 4 mmol/L TEG® ?
Blood components
• Ionised calcium > 1.1
mmol/L as per local
• Platelets > 50 x 109/L ROTEM®/TEG® No MHP
• PT/aPPT < 1.5 x normal algorithm resources
• INR ≤ 1.5 limited?
• Fibrinogen > 2.5 g/L
MHP PACK 1
• RBC 4 units Yes
Monitor (30‒60 minutely) • Fibrinogen concentrate or
• FBC cryoprecipitae to maintain
• Fibrinogen levels fibrinogen > 2.5 g/L
(Clauss lower than PT • FFP 2 units Follow local protocols
derived assays) • POC pathology if available
• Coagulation screen MHP PACK 2 (e.g. i-STAT, Hemocue)
• Ionised calcium • RBC 4 units • Give as available:
• Arterial blood gases • Fibrinogen concentrate or 1. RBC (2 units O negative
State of Queensland (Queensland Health) 2018
cryoprecipitate to maintain or group specific)
If ROTEM®/TEG® fibrogen > 2.5 g/L 2. Fibrinogen concentrate IV
• 10 minutes post blood • FFP 2 units @ 70 mg/kg body weight
components • Platelets 1 adult dose 3. Platelets 1 adult dose
• If ionised calcium < 1.1 4. FFP 2 units
Communication mmo/L, give 10% calcium 5. Crystalloids (up to 1–2 L)
• Notify lab if additional gluconate 10 mL IV 6. Colloids (< 1.5 L)
products required
• Specialist involvement
ASAP
• Check special situations
(e.g. warfarin)
• Notify lab when MHP Yes No
ceased Bleeding
• Keep partner/family controlled?
informed of situation
Lead clinician Haematologist advice
• Repeat blood products
deactivates MHP in response to results
Medical Officers (call senior asap) LAB Theatre
Queensland Clinical Guidelines: Massive haemorrhage protocol (MHP). Flowchart version: F18.1-2-V4-R23
APPT: activated partial thromboplastin time, ASAP: as soon as possible, FBC: full blood count, FFP: fresh frozen plasma, INR:
international normalised ratio, IV: intravenous, MHP: massive haemorrhage protocol, POC: point of care, PPH: postpartum
haemorrhage PT: prothrombin time, RBC: red blood cells, ROTEM®/TEG®: types of blood clotting analysers, <: less than, >: greater
than
Queensland Clinical Guidelines
www.health.qld.gov.au/qcg
