Massive transfusion protocols

Hemorrhage remains a major cause of preventable deaths. From collective civilian and military data, it is known that massive transfusions have proven valuable to the overall survival of trauma patients. The concept of hemostatic resuscitation through the implementation of massive transfusion protocols has been developed to coincide with mechanical interventions such as surgery, preventing death from hemorrhage for patients with life-threatening bleeding from traumatic injury. Massive transfusion protocols allow a balanced resuscitation without exacerbating coagulopathy by dilution of plasma, packed red blood cells (PRBC), and platelets (PLT) as seen previously in unbalanced resuscitative efforts. These protocols use a multidisciplinary approach involving many hospital services and resources. With their development and implementation, a concern has been raised as to how to prospectively identify patients who are at high risk for massive transfusion. We examine the history leading to massive transfusion, development of protocols and delve into the PRospective Observational Multicenter Major Trauma Transfusion trial, which emphasizes the need for redefining massive transfusion.