December 26, 2016 at 4:13 pm #1478Evan PivalizzaParticipant
Hi Reddy, this is exactly the dilemma we are all struggling with – when, if at all, to call futility in these ultra-massive transfusions (as Steve Frank calls them). We have a great relationship with our trauma surgeons and either one of us will often instigate the conversation if it has not been said out loud yet in these situations where we are simply not winning and appears to be futile. I believe we can add useful information to the surgeon who has his/her hands covered in blood if our pressors, acidosis, hemodynamics etc are deteriorating to unsustainable levels despite our collective efforts. We were part of the PROPPR so are comfortable calling a halt to the MTP when clinical conditions and bleeding start improving or we get POC coag results so will need to work on the opposite side of the spectrum. There is still some perceived reluctance to call a stop to an obviously futile situation in the OR and ‘get them to the ICU’ where they succumb a short while later, which is not good stewardship of precious resources.
I would suggest getting together with your surgical and anesthesia colleagues and discuss some of this issues frankly.
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