Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

Alexander P J Vlaar; Joanna C Dionne; Sanne de Bruin; Marije Wijnberge; S Jorinde Raasveld; Frank E H P van Baarle; Massimo Antonelli; Cecile Aubron; Jacques Duranteau; Nicole P Juffermans; Jens Meier; Gavin J Murphy; Riccardo Abbasciano; Marcella C A Müller; Marcus Lance; Nathan D Nielsen; Herbert Schöchl; Beverley J Hunt; Maurizio Cecconi; Simon Oczkowski

doi:10.1007/s00134-021-06531-x

Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

Intensive Care Med. 2021 Dec;47(12):1368-1392. doi: 10.1007/s00134-021-06531-x. Epub 2021 Oct 22.

Authors

Alexander P J Vlaar^#¹, Joanna C Dionne^#^{2

3

4

5}, Sanne de Bruin⁶, Marije Wijnberge^{6

7}, S Jorinde Raasveld⁶, Frank E H P van Baarle⁶, Massimo Antonelli^{8

9}, Cecile Aubron¹⁰, Jacques Duranteau¹¹, Nicole P Juffermans^{12

13}, Jens Meier¹⁴, Gavin J Murphy¹⁵, Riccardo Abbasciano¹⁵, Marcella C A Müller⁶, Marcus Lance¹⁶, Nathan D Nielsen¹⁷, Herbert Schöchl^{18

19}, Beverley J Hunt²⁰, Maurizio Cecconi^{21

22}, Simon Oczkowski^{2

3

4}

Affiliations

¹ Department of Intensive Care Medicine, Amsterdam UMC, Location AMC, Room, C3-430, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. a.p.vlaar@amsterdamumc.nl.
² Department of Medicine, McMaster University, Hamilton, Canada.
³ The Guidelines in Intensive Care Development and Evaluation (GUIDE) Group, He Research Institute St. Joseph's Healthcare Hamilton, Hamilton, Canada.
⁴ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
⁵ Division of Gastroenterology, McMaster University, Hamilton, ON, Canada.
⁶ Department of Intensive Care Medicine, Amsterdam UMC, Location AMC, Room, C3-430, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
⁷ Department of Anaesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
⁸ Department of Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
⁹ Istituto di Anaesthesiology e Rianimazione Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁰ Department of Intensive Care Medicine, Centre Hospitalier Régional et Universitaire de Brest, site La Cavale Blanche, Université de Bretagne Occidentale, Brest, France.
¹¹ Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud (HUPS), Le Kremlin-Bicêtre, France.
¹² Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹³ OLVG Hospital, Amsterdam, The Netherlands.
¹⁴ Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Kepler University, Linz, Austria.
¹⁵ NIHR Leicester Biomedical Research Centre-Cardiovascular, Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK.
¹⁶ Department of Anesthesiology, Intensive Care and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar.
¹⁷ Division of Pulmonary, Critical Care, and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, USA.
¹⁸ Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria.
¹⁹ Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria.
²⁰ Thrombosis and Haemophilia Centre, Guys & St Thomas' NHS Foundation Trust, London, UK.
²¹ Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Centre-IRCCS, Rozzano, MI, Italy.
²² Humanitas University, via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy.

^# Contributed equally.

Abstract

Purpose: To develop evidence-based clinical practice recommendations regarding transfusion practices and transfusion in bleeding critically ill adults.

Methods: A taskforce involving 15 international experts and 2 methodologists used the GRADE approach to guideline development. The taskforce addressed three main topics: transfusion support in massively and non-massively bleeding critically ill patients (transfusion ratios, blood products, and point of care testing) and the use of tranexamic acid. The panel developed and answered structured guideline questions using population, intervention, comparison, and outcomes (PICO) format.

Results: The taskforce generated 26 clinical practice recommendations (2 strong recommendations, 13 conditional recommendations, 11 no recommendation), and identified 10 PICOs with insufficient evidence to make a recommendation.

Conclusions: This clinical practice guideline provides evidence-based recommendations for the management of massively and non-massively bleeding critically ill adult patients and identifies areas where further research is needed.

Keywords: Bleeding; Coagulopathy; Critically ill; Guideline; Intensive care; Plasma; Platelets; Point of care; Red blood cells; Tranexamic acid; Transfusion.

Publication types

Practice Guideline

MeSH terms

Adult
Blood Transfusion
Critical Care*
Critical Illness* / therapy
Hemorrhage / therapy
Humans

Grants and funding

CH/12/1/29419/BHF_/British Heart Foundation/United Kingdom