Purpose of review: This review will address recent developments in the transfusion management of massively transfused trauma patients, focusing on the use of fixed blood component ratios in massive transfusion protocols.
Recent findings: The majority of trauma centers have migrated from laboratory-based transfusion protocols to massive transfusion protocols with fixed blood component ratios. These protocols with red blood cell : plasma : platelet ratio of 1 : 1 : 1 are associated with improved survival in severely injured patients. However, alternate ratios have also demonstrated improved survival. Thus, the optimal ratio has not been determined. In addition, the use of medications, such as antifibrinolytics, and point of care testing, such as thromboelastography, are increasingly being used as part of massive transfusion protocols to adjust transfusion therapy and decrease bleeding. However, their optimal integration has yet to be determined.
Summary: Massive transfusion protocols with fixed ratios of red blood cells to plasma and platelets have improved survival in both civilian and military trauma patients. Continued studies of ratios as well as integration of other therapies and testing are ongoing in order to continue to improve patient outcome.