title: [Management of massive bleeding in 2013: seven questions and answers].
abstract: The management of massive bleeding has improved, thanks to high-quality blood components and new transfusion strategies. However, it remains controversial and, despite a huge body of literature, randomised control trials are still lacking. However, the therapeutic approach has also evolved, requiring earlier and more active management. If a 'no delay' management is well recognized, its modes are still discussed. Immediate delivery of blood products with ratios close to 1:1:1 for RBC units/fresh frozen plasma/platelet concentrates, through massive transfusion protocol using blood packs, has been advocated, but yet this approach is not evidence-based. Secondly, a targeted strategy to provide fibrinogen concentrates is under evaluation. Tranexamic acid is effective in trauma patients. Recombinant factor VIIa should only be used on a compassionate basis.
authors.affiliation: Service d'anesthésie-réanimation, université Paris Descartes, hôpital Cochin, groupe hospitalier Cochin-Hôtel-Dieu, 27, rue du Faubourg-St-Jacques, 75014 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Godier
authors.forename: C M
authors.initials: CM
authors.lastname: Samama
authors.forename: S
authors.initials: S
authors.lastname: Susen
mesh_terms: D000208:Acute Disease; D016913:Blood Component Transfusion / Q000379:methods* / Q000639:trends; D003131:Combined Modality Therapy; D019468:Disease Management; D017707:Erythrocyte Transfusion; D015942:Factor VIIa / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D006470:Hemorrhage / Q000188:drug therapy / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D010949:Plasma; D019106:Postoperative Hemorrhage / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000628:therapy; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use; D014148:Tranexamic Acid / Q000627:therapeutic use
chemical_list: D006490:Hemostatics; D011994:Recombinant Proteins; D014148:Tranexamic Acid; D005340:Fibrinogen; C103587:recombinant FVIIa; D015942:Factor VIIa