Most trauma centers have implemented MTPs that use the strategy of "hemostatic resuscitation." These protocols are highly variable but largely involve minimizing aggressive crystalloid use, delivering early resuscitation with a ratio of blood products that approximates whole blood, and providing early administration of fresh frozen plasm (FFP) and platelets.

At present, the optimal ratio of blood product transfusion is not known. Although more studies are required, current literature shows an association toward increased survival when a ratio of FFP to pRBCs is 1:2 or higher during MT. The Pragmatic, Randomized Optimal Platelets and Plasma Ratios study randomized 680 severely injured patients with trauma to receive FFP:platelets:RBCs in a 1:1:1 or 1:1:2 fashion. The 1:1:1 cohort was found to be noninferior to 1:1:2, as there was no significant difference in mortality or adverse events between the groups.

References

• Griffee MJ, Deloughery TG, Thorborg PA. Coagulation management in massive bleeding. Curr Opin Anaesthesiol. 2010;23:263-268.
• Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313:471-482.
• Ketchum L, Hess JR, Hiippala S. Indications for early fresh frozen plasma, cryoprecipitate, and platelet transfusion in trauma. J Trauma. 2006;60:S51-S58.
• Teixeira PG, Inaba K, Shulman I, et al. Impact of plasma transfusion in massively transfused trauma patients. J Trauma. 2009;66:693-697.