Q: What is the "1:1:1 approach" in trauma patients who may require massive transfusion?

Answer:  Studies have shown that patients who have sustained severe trauma and may require massive transfusion do better if they receive a 1:1:1 ratio of FFP to platelets to RBCs at the outset of resuscitation. Patients with 1:1:1 transfusion strategy are more likely to have adequate hemostasis and fewer exsanguination deaths at 24 hours.

References:

1. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 2007; 63:805.

2. Holcomb JB, Wade CE, Michalek JE, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg 2008; 248:447.

3. Cotton BA, Au BK, Nunez TC, et al. Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. J Trauma 2009; 66:41.

4. Shaz BH, Dente CJ, Nicholas J, et al. Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients. Transfusion 2010; 50:493.

5. de Biasi AR, Stansbury LG, Dutton RP, et al. Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma (CME). Transfusion 2011; 51:1925.