BACKGROUND:
Massive hemorrhage (MH) is a leading cause of perioperative mortality (1). Definition: blood loss exceeding circulating blood volumen within a 24 hour period. Massive Transfusion (MT) is the administration of  ≥10 red blood cell (RBC) units during that period of time, > 4 RBC units in 1 hour or the replacement of  more than 50% of the total blood volume within 3 hours.  The aim of our study is to describe the management of MH at a spanish tertiary referral hospital according to the existing MH protocol and the mortality of massively transfused patients. 
MATERIALS AND METHODS:

We conducted a retrospective study of transfusion practice ( 1st July 2015 to  1st July 2016) at our hospital. The study was based on the blood bank database and the revision of clinical histories, including all patients receiving 8 or more RBC units within 24 hours. 
Age, sex, department, primary diagnosis, hemoglobin threshold for transfusion, number of RBC units, fresh frozen plasma units ( FFC), platelet pools and complementary therapies ( embolization, packing etc…) were recorded. 30-day mortality after MT episode was also assessed. 

RESULTS AND DISCUSSION:

A total of 22117 received transfusions , the episodes of MT were 3,35 (n=70).  The MH protocol was activated with every of the 70 patients. 
2/3 of the patients were male.  Anaesthesiology department carried out 75,7% of the MT (n=53). The main indications for MT were: procedural complications 22,9% (n=16); elective surgery 22,9% (n=16); Medical causes 20% (n=14); Polytraumatism 18,6% (n=13); Transplantation 8,6% (n=6); Postpartum hemorrhage (PPH) 7,1% (n=5). The hemoglobin threshold for transfusion was 7,84 g/dl ± 2,16. The average number of blood components that were administered was: RBC units 13,79±6,52, FFP 5,31±3,33, platelets 1,67±1,3. Fibrinogen was administered in 21,43% (n=15) (mainly in polytraumatized patients and PPH). Complementary therapies were performed in 21,4% of the patients with MH. The 30- day mortality was 41,4%. Disregarding HPP mortality increased over 44,6%. The highest mortality was found in: Medical causes (58,3%), polytraumatism (64,3%), procedural complications (44,4%). We did not observe statiscal significance between total number of blood components administered and 30-day mortality. 

CONCLUSIONS:
-	The vast majority of MT occur in elective surgery and procedural complications. 
-	MT mortality is still very high. 
REFERENCES:
1.- Märit Halmin et al. Epidemiology of massive transfusion: A binational study from Sweden and Denmark. Crit Care Medicine 2016: 44, 3.
2.- H.P. Pham and B.H. Shaz. Update on massive transfusion. BJA 111 (S1): i71-i82 (2013).
3.-Rossaint et al. The european guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Critical care (2016) 20:100.

Management of massive haemorrhage: results from our protocol activation