In massive transfusion protocol from suspected hemorrhage, is it worth obtaining a TEG to guide transfusion?

There really is no evidence (except expert opinion) on massive transfusion protocols and outcomes. There are a few trials showing that TEG or other viscoelastic tests reduce transfusion and even improve survival or other important outcomes in hemorrhage. So given the choice, if rapid point of care TEG or ROTEM or Quantra is available, I would advise using that to guide transfusion of platelets, plasma and cryo. All patients, with some exceptions, should receive tranexamic acid, based upon randomized trials. Formulaic massive transfusion protocols make sense in many situations but are neither evidence based nor a panacea. They often lead to administering plasma, platelets and cryo to patients with moderate bleeding (say 3-4 rbc), and this is...