Secondary Logo

Journal Logo

Massive Transfusion Protocols

When to Turn On, and Off, the Fire Hose

Wanderer, Jonathan P., MD, MPhil; Nathan, Naveen, MD

doi: 10.1213/ANE.0000000000002617
Infographics: Infographic

Vanderbilt University School of Medicine (

Northwestern University Feinberg School of Medicine (

The Infographic is composed by Jonathan P. Wanderer, MD, MPhil, Vanderbilt University School of Medicine (, and Naveen Nathan, MD, Northwestern University Feinberg School of Medicine ( Illustration by Naveen Nathan, MD.

The authors declare no conflicts of interest.



Massive transfusion protocols (MTP) guide management of severe hemorrhage with fixed-ratio transfusion of blood product. Implementation of these protocols in trauma settings has been associated with improved patient outcomes, reduction of blood production utilization and waste, and reduced transfusion complications. While adoption of MTP by academic medical centers has been robust, much practice variation exists around its initiation and termination. In this infographic, we compare 2 scoring systems used to inform the initiation of MTP, review common fixed ratios for MTP, and describe factors important to understand when terminating MTP.

FFP indicates fresh frozen plasma; MTP, massive transfusion protocols; PRBCs, packed red blood cells.

Back to Top | Article Outline


1. Foster JC, Sappenfield JW, Smith RS, Kiley SPInitiation and termination of massive transfusion protocols: current strategies and future prospects. Anesth Analg. 2017;125:2045–2055.
© 2017 International Anesthesia Research Society