Background Accidental injury is one of the leading causes of death in the United States and worldwide. Severe hemorrhage from injury is the leading cause of preventable death. Effective management of hemorrhaging trauma patients has been evolving since the early 1900’s. Recent studies have demonstrated the benefits of using a balanced resuscitation technique, revolving around the goal of recreating whole blood. The purpose of this project was to identify what ratios of blood products are being transfused at Providence Sacred Heart Medical Center (PSHMC) and Providence Holy Family Hospital (PHFH).

Methods A literature review was performed identifying seven high quality peer-reviewed studies. • Institutional approval and IRB review for exemption determination completed. Human subjects were protected. • Registry data extraction in an anonymized fashion. • Patients who received no packed red blood cells or had no age specified were excluded. • Patients organized by demographic and clinical characteristics. • 24-hour mortality rates extracted from the electronic health record. • Post hoc power analysis was completed. • High ratio transfusion was defined as a ratio approaching or greater than 1:1 with packed red blood cells always being the denominator (i.e. FFP:PRBC, PLT:PRBC).

Discussion Massive transfusion ratios among hemorrhaging patients at PSHMC and PHFH were observed at high ratio 35% of the time, when comparing fresh frozen plasma to packed red blood cells, and 49% of the time, when comparing platelets to packed red blood cells. Trauma patients account for 39% of all massive transfusions at PSHMC and PHFH. Though some cases of massive transfusions observed in this project did achieve high transfusion ratios, it is unclear what reasons prevented high transfusion ratios. Research evidence suggest that mortality risk is higher when lower ratios are utilized during massive transfusions. However, this project was not powered to detect mortality differences by ratios.