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    Massive Haemorrhage Protocol (MHP) : Lead Clinician Activates MHP

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    Massive Haemorrhage Protocol (MHP) : Lead Clinician Activates MHP

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    onlyhamster
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    f-pph-mhp

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    Massive Haemorrhage Protocol (MHP) : Lead Clinician Activates MHP

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    onlyhamster

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    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

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