Successful emergency transfusions require early recognition and activation of resources to minimize treatment delays. The initial goals should focus on replacement of blood in a balanced fashion. There is an ongoing debate regarding the best approach to transfusions, with some advocating for resuscitation with a fixed ratio of blood products and others preferring to use viscoelastic assays to guide transfusions. Whole-blood transfusion also is a debated strategy. Despite these different approaches, it generally is accepted that transfusions should be started early and crystalloid infusions limited. As hemodynamic stability is restored, endpoints of resuscitation should be used to guide the resuscitation.
Farrell MS, Kim WC, Stein DM. Emergency Transfusions. Emerg Med Clin North Am. 2020 Nov;38(4):795-805. doi: 10.1016/j.emc.2020.06.005. Epub 2020 Jul 21. PMID: 32981618.