Cardiothoracic trauma patients are frequently hypovolemic and hypothermic and may require massive transfusion, which can itself cause such complications as acidosis, electrolyte imbalance (hypocalcemia and hyperkalemia), hypothermia, dilutional coagulopathy, and adult respiratory distress syndrome. At the present time, there are a number of rapid infusion devices such as Level P (capable of delivering 370C at a flow rate of up to 600 ml/min), Fluid Management System® (FMS®) (which can deliver 37.50C of fluid at a flow rate of up to 500 ml/min), Rapid Infusion System® (RIS®) (which can provide up to 1,500 ml of 37°C fluid in one and one half minutes), and Rapid Solution Administration Set® (RSASO) (which can not only deliver a maximum of 2,200 m/min, but can warm the fluid to normothermia at a flow rate of 500 ml/min). However, pressurized devices such as Level IO can cause air embolism, interstitial infiltration and the compartment syndrome, and the flow rate is not operator-controlled. Devices such as FMS®, RIS®, and RSAS® incorporate a cardiotomy reservoir which has the potential for clot formation when any calcium-containing solution is added. In this article, rapid infusion devices are compared, and complications associated with massive transfusion are described.TjIrauma is the leading cause of death in the age I group from birth to 30 years, and more than 100,000 trauma-related deaths occur each year in the United States.' Thoracic trauma is the third most common major trauma after extremity and head trauma, and two thirds of them are attributed to motor vehicle accidents.2 Most fatalities are caused by penetrating or blunt trauma to the chest. Blunt chest injury includes rib fractures, flail chest, cardiopulmonary contusion, pneumothorax, and cardiac tamponade. Aortic tear or dissection is a serious injury, and 70% of them will rupture within 24 hours if undiagnosed.