title: 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 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.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada. Electronic address: hoamh@hotmail.com.
authors.forename: Anthony M-H
authors.initials: AM
authors.lastname: Ho
authors.affiliation: Department of Surgery, University of Texas at Houston, Houston, TX.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Hong Kong.
authors.forename: Calvin S H
authors.initials: CS
authors.lastname: Ng
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Zamora
authors.affiliation: Department of Anaestheisa and Intensive Care, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Karmakar
authors.affiliation: Department of Anaesthesia, St Catharines General Hospital, St Catharines, Ontario, Canada.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dion
mesh_terms: D016913:Blood Component Transfusion / Q000379:methods* / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards*; D004636:Emergency Service, Hospital; D017707:Erythrocyte Transfusion; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D010949:Plasma; D017713:Platelet Transfusion; D014947:Wounds and Injuries / Q000150:complications*