Studies of platelets-to-PRBC ratios have shown similar improvements in mortality, with higher ratios among patients undergoing MT (Table 4).
Lastly, studies of fibrinogen replacement have also supported both protocolized and TEG/ROTEM-guided supplementation of fibrinogen in the resuscitation of patients undergoing MT.
In contrast to FFP and platelets, which are available as single and pooled donor units only, fibrinogen can be supplemented using cryoprecipitate for transfusion or through administration of a concentrate derived from human plasma. Each vial contains between 900 and 1300 mg of lyophilized fibrinogen, which is reconstituted in as little as 50 mL of saline. Overall, a benefit does appear to be demonstrated from higher FFP-to-PRBC, platelets-to-PRBC, and fibrinogen-toPRBC ratios during acute resuscitation of the MBL/MT patient. Although the ideal ratio of each component is still unknown, 2 prospective trials are currently enrolling patients in an attempt to further delineate the ideal ratio of blood components for resuscitation and to answer definitively the question of survivor bias.