The traditional vs “1:1:1” approach debate on massive transfusion in trauma should not be treated as a dichotomy

Abstract Traditional transfusion guidelines suggest that fresh frozen plasma (FFP) should be given based on laboratory or clinical evidence of coagulopathy or acute loss of 1 blood volume. This approach tends to result in a significant lag time between the first units of erythrocytes and FFP in trau...

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Bibliographic Details
Published in:The American journal of emergency medicine 2015-10, Vol.33 (10), p.1501-1504
Main Authors: Ho, Anthony M.-H., MD, Holcomb, John B., MD, Ng, Calvin S.H., MD, Zamora, Jorge E., MD, Karmakar, Manoj K., MD, Dion, Peter W., PhD, MD
Format: Article
Language:English
Subjects:
Blood Component Transfusion - methods
Blood Component Transfusion - standards
Blood platelets
Blood products
Clinical Protocols - standards
Emergency
Emergency medical care
Emergency Service, Hospital
Erythrocyte Transfusion
Hemorrhage - therapy
Humans
Injuries
Laboratories
Mortality
Patients
Plasma
Platelet Transfusion
Trauma centers
Wounds and Injuries - complications
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Summary:Abstract Traditional transfusion guidelines suggest that fresh frozen plasma (FFP) should be given based on laboratory or clinical evidence of coagulopathy or acute loss of 1 blood volume. This approach tends to result in a significant lag time between the first units of erythrocytes and FFP in trauma requiring massive transfusion. In severe trauma, observational studies have found an association between increased survival and aggressive use of FFP and platelets such that FFP:platelet:erythrocyte ratio approaches 1:1:1 to 2 from the first units of erythrocytes given. There are considerable concerns over either approach, and no randomized controlled trials have been published comparing the 2 approaches. Nowadays, trauma clinicans are incorporating the strenghts of both approaches and are no longer treating them as a dichotomy. Specifically, “1:1:1” proponents have devised 1:1:1 activation criteria to minimize unnecessary FFP and platelet transfusion and are prepared to deactivate the protocol as soon as patient is stabilized. Similarly, 1:1:1 skeptics are more mindful of the need to be proactive about trauma coagulopathy and the inherent delays in FFP administration in trauma patients.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2015.06.065