Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center.

The authors implemented a massive transfusion protocol (MTP) designed to achieve a packed red blood cell:FFP:platelet ratio of 1:1:1 in a civilian trauma context. Comparison of mortality rates before and after the change suggests that the aggressive use of FFP and platelets may contribute to a reduction of mortality, especially in the subset of blunt trauma patients. While the results of this study agree with the conclusions of similar trials conducted in the military, the available evidence (in civilian trauma) is still conflicting. Only randomized controlled trials will allow us to determine the optimal red blood cell:FFP:platelet ratio in different massively transfused patient populations.

– Jean-Franois Hardy