Trial reportCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2013
Effect of a fixed-ratio (1:1:1) transfusion protocol versus laboratory-results-guided transfusion in patients with severe trauma: a randomized feasibility trial.
Trial report in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00945542 (Formula-driven vs Laboratory-guided Transfusion Practices in Bleeding Trauma Patients), which is not on this map. Cited by 41 papers, 9 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Formula-driven vs Laboratory-guided Transfusion Practices in Bleeding Trauma Patients: A Feasibility Randomized Controlled Study
Who cites it
41 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- Inhospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - a systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Blood transfusion strategies for major bleeding in trauma.The Cochrane database of systematic reviews · 2025Pooled it
- Heterogeneity in defining multiple trauma: a systematic review of randomized controlled trials.Critical care (London, England) · 2023Pooled it
- Definitions of massive transfusion in adults with critical bleeding: a systematic review.Critical care (London, England) · 2023Pooled it
- The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition.Critical care (London, England) · 2023Guideline
- Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review.World journal of emergency surgery : WJES · 2022Pooled it
- Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine.Intensive care medicine · 2021Guideline
- Platelet-to-red blood cell ratio and mortality in bleeding trauma patients: A systematic review and meta-analysis.Transfusion · 2021Pooled it
- Pooled it
- Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial.Lancet (London, England) · 2018Trial
- Trial
- Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation.Injury · 2014Trial
- VHA-guided resuscitation and post-24-hour survival in traumatic hemorrhage: a propensity- matched retrospective cohort study from China.Frontiers in medicine · 2026Article
- The Effect of Heterogeneous Definitions of Massive Transfusion on Using Blood Component Thresholds to Predict Futility in Severely Bleeding Trauma Patients.Journal of clinical medicine · 2025Review
- Transfusion ratios and survival in severe blunt trauma patients receiving massive transfusion.Scientific reports · 2025Article
- Transfusion in trauma: empiric or guided therapy?Research and practice in thrombosis and haemostasis · 2025Article
- Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Management of critical bleeding.Hematology, transfusion and cell therapy · 2024Article
- Coagulopathy management of multiple injured patients - a comprehensive literature review of the European guideline 2019.EFORT open reviews · 2022Review
- Economic impact of a machine learning-based strategy for preparation of blood products in brain tumor surgery.PloS one · 2022Article
- Traumatic Suprahepatic inferior vena cava injury survival of a rare case.Trauma case reports · 2021Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHemorrhage coupled with coagulopathy remains the leading cause of preventable in-hospital deaths among trauma patients. Use of a transfusion protocol with a predefined ratio of 1:1:1 (1 each of red blood cells [RBC], frozen plasma [FP] and platelets) has been associated with improved survival in retrospective studies in military and civilian settings, but such a protocol has its challenges and may increase the risk of respiratory complications. We conducted a randomized controlled trial to assess the feasibility of a 1:1:1 transfusion protocol and its effect on mortality and complications among patients with severe trauma.
methodsWe included 78 patients seen in a tertiary trauma centre between July 2009 and October 2011 who had hypotension and bleeding and were expected to need massive transfusion (≥ 10 RBC units in 24 h). We randomly assigned them to either the fixed-ratio (1:1:1) transfusion protocol (n = 40) or to a laboratory-results-guided transfusion protocol (control; n = 38). The primary outcome, feasibility, was assessed in terms of blood product ratios and plasma wastage. Safety was measured based on 28-day mortality and survival free of acute respiratory distress syndrome.
resultsOverall, a transfusion ratio of 1:1:1 was achieved in 57% (21/37) of patients in the fixed-ratio group, as compared with 6% (2/32) in the control group. A ratio of 1:1 (RBC:FP) was achieved in 73% (27/37) in the fixed-ratio group and 22% (7/32) in the control group. Plasma wastage was higher with the intervention protocol (22% [86/390] of FP units v. 10% [30/289] in the control group). The 28-day mortality and number of days free of acute respiratory distress syndrome were statistically similar between the groups.
interpretationThe fixed-ratio transfusion protocol was feasible in our study, but it was associated with increased plasma wastage. Larger randomized trials are needed to evaluate the efficacy of such a protocol in trauma care.
trial registrationClinicalTrials.gov, no. NCT00945542.
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