American College of Surgeons Committee on Trauma (2014). ACS TQIP Massive Transfusion in Trauma Guidelines.


Guideline Recommendation:

An appropriate ICU-driven algorithm should be optimized to use blood components for goal-directed therapy.

  • Upon arrival in the ICU, baseline laboratory measures should be obtained and then repeated as needed or at least hourly: INR, aPTT, fibrinogen level, hemoglobin or hematocrit, platelet count, viscoelastic point-of-care testing (if available), ionized calcium, blood gas testing (including base deficit).
  • Once laboratory data are available, resuscitation should be goal directed based on the laboratory findings and clinical evidence of ongoing bleeding.