Schochl and co-authors have described a 5-year retrospective study that outlines a novel, important and controversial transfusion concept in seriously injured trauma patients. Traditionally, clinicians have been taught to use a serial approach, resuscitating hypovolemic trauma patients with a form of crystalloid or colloid, followed by red blood cells (RBCs), then fresh frozen plasma (FFP), and lastly platelets. The data supporting this widely accepted approach are remarkably weak. Conversely, Schochl and colleagues, in an innovative, retrospective study, describe the use of fibrinogen concentrate, plasma complex concentrate, RBCs, FFP, and platelets driven by a thromboelastometry-based algorithm. Finally, it appears that transfusion therapy is becoming driven by physiology.
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