A trauma patient requires massive transfusion protocol (MTP) activation. Which product ratio has been demonstrated to best improve survival in major haemorrhage based on PROPPR trial data?

• A pRBC : FFP : platelets = 2:1:1
• B pRBC : FFP : platelets = 4:2:1
• C pRBC : FFP : platelets = 1:2:1
• D pRBC : FFP : platelets = 1:1:1 ✓

Explanation

The PROPPR (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) trial demonstrated that a 1:1:1 ratio of packed red blood cells to fresh frozen plasma to platelets achieved haemostasis sooner and reduced 24-hour mortality compared to a 1:1:2 ratio. This strategy is termed 'damage-control resuscitation,' replacing empirical crystalloid resuscitation with balanced blood product therapy. The 4:2:1 ratio represented older practice and is now superseded by balanced haemostatic resuscitation.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.