Changing Paradigms in Hemostatic Resuscitation: Timing, Extent, Economic Impact, and the Role of Factor Concentrates

Damage-controlled hemostatic resuscitation has become a standard of care for critically injured patients. Recently completed PROPRR trial demonstrated hemostatic benefits of 1:1:1 Platelets:FFP:RBC transfusion approach, although overall mortality did not decrease. Improved logistics of resuscitation (decreased crystalloid administration), optimization of blood product delivery with adoption of massive transfusion protocols (short time to first unit of plasma transfused), and better early post-MTP management are the factors that contributed to lower than expected mortality in this study. Liquid plasma and pre-thawed Type A fresh frozen plasma (FFP) are safe alternatives to universal donor Type AB FFP and have been adopted by few trauma centers in North America due to shortage of AB FFP supply