In massive transfusion protocols (MTP), the PROPPR trial (2015) established an optimal ratio for plasma:platelets:packed red blood cells. What ratio was demonstrated to improve 24-hour survival and hemostasis?
- A 1:1:1 (plasma:platelets:PRBC) — balanced transfusion reduces mortality ✓
- B 1:2:4 (plasma:platelets:PRBC) — more PRBC and less plasma
- C Crystalloid-first approach with blood products only after coagulopathy is confirmed
- D 0:0:1 — PRBC only until coagulation tests are available
Correct answer: A. 1:1:1 (plasma:platelets:PRBC) — balanced transfusion reduces mortality
Explanation
The PROPPR trial (Holcomb et al., JAMA 2015) randomized 680 patients with severe trauma and massive hemorrhage to 1:1:1 vs 1:1:2 plasma:platelets:PRBC ratios. The 1:1:1 group had significantly better 24-hour hemostasis (86% vs 78%) and a trend toward improved 30-day survival. The 1:1:1 ratio also reduced the number of patients dying from hemorrhage within 24 hours. This established the 1:1:1 balanced component transfusion (damage control resuscitation) as the standard for massive transfusion, replacing the historical 'crystalloid-first' approach.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.