Managing Life-Threatening Hemorrhage: Building Consensus Beyond Protocols

In this discussion, Dr. Brodie Nolan and a multidisciplinary panel use real-world scenarios to build practical consensus on alternative hemostatic blood products in life-threatening hemorrhage——particularly when resources, testing, and time to definitive care vary across sites. Through audience polling and panel debate, the session highlights where practice is converging and where uncertainty remains: the role of PCC versus plasma in early rural trauma transfers when laboratory or viscoelastic testing is unavailable; the use of empiric fibrinogen replacement in well-resourced centres in light of current trial evidence, while recognizing scenarios such as prolonged bleeding, delayed transport, and evolving physiology where clinicians may need to act on phenotype rather than a single laboratory value; and the context-dependent use of TXA, with strong support in early trauma and postpartum hemorrhage and continued nuance in gastrointestinal bleeding.

Overall, the discussion reinforces that protocols should enable thoughtful decision-making rather than enforce rigid rules.