Reply to comment on: Massive transfusion experience, current practice and decision support: A survey of Australian and New Zealand Anaesthetists

We would like to congratulate Dr Miller and colleagues on developing a smartphone application to provide clinical decision support (CDS) for interpreting rotational thromboelastometry (ROTEM; TEM international GmbH, Munich, Germany), a form of viscoelastic haemostatic assay (VHA) for pointof- care coagulation assessment in the context of massive transfusion (MT). MT is a complex and multifaceted task that can occur unpredictably and require significant resources at a moment's notice. Cognitive aids and CDS as paper-based or electronic tools are increasingly used in resuscitation scenarios. MTs are also commonly protocol-based, where institutional massive transfusion protocols (MTP) are used to direct staff, determine blood products to be transfused, provide goals of care and provide CDS to clinicians, and therefore lend themselves towards an electronic CDS solution, given their complexity. Despite the adoption of point-of-care coagulation assessment into clinical practice for the management of major haemorrhage, its benefit in MT has not yet been established. A recent trial that compared VHA-based management of major trauma haemorrhage versus use of conventional coagulation testing found no difference in patient outcomes.