Q: What does FFP/RBC ratio mean in massive transfusion?

Answer:  Trauma literature  regarding  Massive Transfusion Protocol (MTP) lean towards higher FFP:RBC ratio. The thought process behind this approach is that the body's physiologic response to major trauma results in the triad of acidosis, hypothermia and coagulopathy, which eventually results in further massive blood loss. Replacement of coagulation factors may result in better control of bleeding.


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;63:805–813. 

2. Holcomb JB, Wade CE, Michalek JE, et al. Increased plasma and platelet to red blood cell ratios improve outcome in 466 massively transfused civilian trauma patients [published correction appears in Ann Surg. 2011;253:392 

3. Zink KA, Sambasivan CN, Holcomb JB, et al. A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study. Am J Surg. 2009;197:565–570.