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High-Flow Fluid Warming Massive Transfusion — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaHigh-Flow Fluid Warming Massive TransfusionFRCA Final

A 60-year-old man (ASA III) undergoes emergency laparotomy. He weighs 85 kg. Estimated blood loss is 3 litres. He has received 4 units of PRBCs and 4 units of FFP. His core temperature is 34.2°C. Which warming device is most effective for rapid IV fluid warming?

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Correct answer: A — High-flow fluid warming device (e.g., Level 1, Belmont, enFlow) capable of warming at high flow rates

For massive transfusion, a high-flow fluid warming device (Level 1/Belmont Rapid Infuser or similar) is the most effective method of warming blood products and crystalloids during rapid infusion. These devices warm fluid to 37-41°C at flow rates up to 500-1000 mL/min, preventing the further hypothermia that would result from infusing large volumes of cold blood products (stored at 4°C). Standard in-line fluid warmers are adequate for routine infusions but cannot maintain adequate warming at the high flow rates needed during massive transfusion. The forced air blanket warms the patient externally but does not address cold fluid administration.

Reference: NICE – 2016 – CG65 Perioperative hypothermia; Association of Anaesthetists – 2025 – Blood components