Background Massive bleeding is a major cause of death both in trauma and non-trauma patients. In trauma patients, the implementation of massive transfusion protocols (MTP) led to improved outcomes. However, the majority of patients with massive bleeding are non-trauma patients. Objectives To assess if the implementation MTP in non-trauma patients with massive bleeding leads to improved survival. Data sources National Library of Medicine's Medline database (PubMed). Study eligibility criteria Original research articles in English language investigating MTP in non-trauma patients. Participants Non-trauma patients with massive bleeding 18 years of age. Intervention Transfusion according to MTP versus off-protocol. Study appraisal and synthesis methods Systematic literature review using PubMed. Outcomes assessed were mortality and transfused blood products. Studies that compared mortality of MTP and non-MTP groups were included in meta-analysis using Mantel-Haenszel random effect models.