The ratio of fibrinogen to red cells transfused affects survival in casualties receiving massive transfusions at an Army combat support hospital

Background: To treat the coagulopa-thy of trauma, some have suggested early and aggressive use of cryoprecipitate as a source of fibrinogen. Our objective was to determine whether increased ratios of fi-brinogen to red blood cells (RBCs) de-creased mortality in combat casualties requiring massive transfusion. Methods: We performed a retrospec-tive chart review of 252 patients at a U.S. Army combat support hospital who re-ceived a massive transfusion (>10 units of RBCs in 24 hours). The typical amount of fibrinogen within each blood product was used to calculate the fibrinogen-to-RB