Massive transfusion in trauma: an evolving paradigm.

A considerable amount of literature has nurtured the idea that massive transfusion is an independent trauma disease and therapeutic tool. In this opinion paper, the authors expose the evolution and challenge the classic paradigm and historic definition of massive transfusion. Based on current evidence the elements of an evolving strategy in transfusion management and bleeding control are exposed to use of tranexamic acid, combination and ratios of blood products, use of fluids and viscoelastic testing, etc. The synergy of these elements provides the basis to develop updated strategies and perspectives for transfusion management after trauma and to consider a classic definition of massive transfusion as outdated or the need for massive transfusion as failure. An alternative concept, time critical transfusion may be better placed to take into account modern transfusion management after trauma.