Note that hypomagnesemia is also common in trauma patients and is worsened by citrate- containing blood products. Hypomagnesemia may contribute to increased cardiac irritability and risk of fatal arrhythmias. Consideration should be given to replacing magnesium in the setting of severe hypocalcemia and massive transfusion.4,78-80

The use of rFVIIa is no longer recommended in most trauma patients since it has not been shown to reduce mortality and may increase risk of adverse events.81-85