MANAGEMENT OF SEVERE HEMORRHAGIC SHOCK: RESUSCITATION, MASSIVE TRANSFUSION PROTOCOLS AND EARLY MANAGEMENT OF COAGULOPATHY

Severe hemorrhagic shock remains one of the leading causes of potentially preventable death after trauma, requiring immediate recognition, rapid bleeding control, and early hemostatic resuscitation. This study aimed to analyze current evidence regarding resuscitation, massive transfusion protocols, and early management of coagulopathy in adults with severe traumatic hemorrhage. An integrative literature review was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science, including publications from 2010 to September 14, 2026. Study screening was independently performed by two reviewers using the Rayyan platform. Of 995 records identified, 247 duplicates were removed, 39 full-text articles were assessed, and 23 primary studies comprised the final sample. Evidence supports restricted crystalloid administration, balanced transfusion strategies, early use of tranexamic acid, and targeted correction of coagulation abnormalities. Empirical administration of fibrinogen, cryoprecipitate, or prothrombin complex concentrate did not consistently improve clinical outcomes, while recent randomized trials failed to demonstrate superiority of whole blood over component therapy. Therefore, management of severe hemorrhagic shock should be early, protocolized, and progressively individualized, combining rapid hemorrhage control, hemostatic resuscitation, and continuous physiologic and coagulation monitoring.