In a patient with haemorrhagic shock following trauma, which initial resuscitation fluid strategy has been shown to improve outcomes compared with early crystalloid-predominant resuscitation?

• A Damage-control resuscitation with balanced blood products in a 1:1:1 ratio (pRBC:FFP:platelets) ✓
• B Hypertonic saline 7.5% bolus to restore osmolarity
• C Aggressive crystalloid resuscitation targeting MAP > 75 mmHg before haemostasis
• D Colloid-only resuscitation with albumin 5% to maintain oncotic pressure

Explanation

The PROPPR trial and subsequent evidence support damage-control resuscitation (DCR) using balanced blood products in a 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets, which mirrors whole blood composition and addresses the lethal triad of coagulopathy, acidosis, and hypothermia in major trauma. Early crystalloid-predominant resuscitation dilutes clotting factors, worsens coagulopathy, and increases abdominal compartment syndrome risk. Hypertonic saline may reduce intracranial hypertension but is not established as a primary resuscitation fluid in trauma haemorrhage. Permissive hypotension (MAP ~50 mmHg) is maintained until surgical haemostasis in penetrating trauma.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.