It comes as no surprise that trauma centers are confused! Given the absence of data from randomized controlled trials on the efficacy and on the safety of different massive transfusion protocols (MTP), physicians and organizations initiate MTP to the best of their knowledge. Unfortunately, this knowledge is based on retrospective and, often, contradictory reviews of military and civilian trauma databases. RCTs will be essential to resolve these issues but will be extraordinarily difficult to conduct. See also Nascimento B et al. Clinical review: Fresh frozen plasma in massive bleedings – more questions than answers. Crit Care 2010;14:202.

– Jean-Franois Hardy

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