Sanne de Bruin

61 Transfusion practice in the bleeding critically ill; an international online survey – The TRACE-2 Survey Massive bleeding Product choice Approximately half of the respondents (46%) used fixed blood product ratios (RBC: Plasma: PLT). Among these respondents, the 1:1:1 ratio was most often reported (33%) followed by 3:3:1 ratio (24%). During massive bleeding, the use of blood products was most often guided by viscoelastic testing (73%) and conventional laboratory-based testing (67%). The use of fibrinogen and prothrombin complex concentrate (PCC) during massive bleeding was highly variable: fibrinogen was most often (36%) administered based on conventional laboratory-based tests or empirically followed by laboratory test guided additional fibrinogen administration (30%). Viscoelastic testing was used by 19%of the respondents and 11% administered fibrinogen only empirically. Prothrombin complex concentrate administration was most often guided by conven- tional laboratory-based testing (39%) followed by viscoelastic testing (23%) and 21% stated they initially administered PCC empirically but titrated the following doses based on conventional laboratory results. Themajority (93%) of the respondents usedTXA duringmassive bleeding. Among those respondents, it was usually administered empirically (89%), but 9% used viscoelastic tests to guide the administration of TXA. Large differences were observed between different subpopulations (Figure 2A). The subpopulations where most respondents would always administer TXA were trauma patients (59%), followed by massively bleeding obstetric patients (40%). Few respondents would always administer TXA to septic patients (11%). In patients on extra- corporeal membrane oxygenation (ECMO), respondents most often stated they would never use TXA for this patient population (35%). More data regardingmassive bleeding is displayed in table 2. Correcting iatrogenic coagulopathy during massive bleeding The strategy to correct iatrogenic coagulopathy was dependent on the class of an- ticoagulant medication that was used. In patients with a vitamin K antagonist (VKA) induced coagulopathy (defined as an INR >1.5x reference value), most respondents would treat this by administering vitamin K (68%), PCC (78%) and plasma (61%). When the coagulopathy was direct oral anticoagulant (DOAC)-induced, respondents would 3