Florian Roquet, PhD laureate, under the supervision of Romain Pirracchio, M.D., MPH, Ph.D., San Francisco, USA

Hemostatic resuscitation is a crucial aspect of managing trauma patients, but the practices in France are not well-known. This thesis describes the current practices of administering coagulation factors and investigates the fresh frozen plasma (FFP) to red blood cell (RBC) ratio in severely injured trauma patients. Analysis of a patient cohort shows that the primary hemostatic strategy in cases of major hemorrhage combines the administration of FFP and fibrinogen concentrates (FC), with considerable heterogeneity between centers and significant discordance with existing recommendations. To improve these practices, early administration of coagulation factors should be increased, viscoelastic tests should be used for targeted hemostatic resuscitation, and a sustained effort should be made to promote adherence to recommendations.
The study aims to answer the question of the FFP:RBC ratio in severely injured trauma patients. The results show that in patients with severe trauma, an early transfusion strategy based on a high FFP:RBC ratio (>1:1.5) is associated with a decrease in 30-day mortality. These findings underscore the importance of rapid and targeted hemostatic resuscitation in severely injured trauma patients to improve their survival.
This thesis provides an overview of current hemostatic resuscitation practices in France and evaluates the impact of the transfusion ratio on the survival of severely injured trauma patients. The results highlight the importance of early and targeted hemostatic resuscitation to improve the survival of severely injured trauma patients and suggest areas for improvement in hemostatic resuscitation practices.