Intraoperative Massive Blood Loss - Guidelines for Crises in Anaesthesia

Expected or unexpected major haemorrhage



❶ Call for help, inform theatre team of problem and note the time.

❷ Increase FiO2 and consider cautiously reducing inhalational/intravenous anaesthetics.

❸ Check and expose intravenous access.

❹ Control any obvious bleeding (pressure, uterotonics, tourniquet, haemostatic dressings).

❺ Call blood bank (and assign one person in theatre to liase with them):

  • Activate major haemorrhage protocol.

  • Communicate how quickly blood is required.

  • Communicate how much blood and blood product is required.

❻ Begin active patient warming.

❼ Use rapid infusion and fluid warming equipment.

❽ Discuss management plan between surgical, anaesthetic and nursing teams:

  • Liaise with haematologist if necessary (Box A).

  • Consider interventional radiology.

  • Consider use of cell salvage equipment.

❾ Monitor progress:

  • Use point of care testing: Hb, lactate, coagulation, etc.

  • Use lab testing: including calcium and fibrinogen.

❿ Replace calcium and consider giving tranexamic acid (Box C).

⓫ If bleeding continues consider giving recombinant factor VIIa: liase with haematologist.

⓬ Plan ongoing care in an appropriate clinical area.



By Association of Anaesthetists @ https://twitter.com/AAGBI

Quick Reference Handbook - Guidelines for crises in anaesthesia 



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