The article by Mell et al. is a retrospective observational single-center study assessing the relationship between transfusion ratios of PRBC:FFP and mortality in patients undergoing operative repair of ruptured abdominal aortic aneurysm (rAAA) over a 20-year period (from 1987 to 2007). A total of 128 rAAA patients receiving > 10 RBC units from admission and throughout surgery were included and, in multivariate analysis, 30-day mortality was markedly lower (15% ivs./i 39%; P < 0.03) in patients transfused at a PRBC:FFP ratio < 2:1 (HIGH FFP group) compared with those transfused at a ratio of > 2:1 (LOW FFP group). The authors conclude that prospective studies evaluating the optimal RBC:FFP ratios are warranted.

Unfortunately, and somewhat surprisingly, no report of platelet transfusions is provided although this has previously been reported to be significantly associated with outcome of rAAA patients. Furthermore, a discussion regarding goal-directed hemostatic resuscitation based on whole blood viscoelastical assays instead of “blind” administration based on fixed ratios of PRBC:FFP is also lacking, and this limits the clinical importance of the study.

– Pr Johansson