Massive transfusion protocol (MTP) for trauma haemorrhage guides empiric blood product ratios before laboratory results. The current evidence-based ratio from the PROPPR trial is:
- A 2:1:1 (pRBC:FFP:platelets) is optimal based on PROPPR trial data
- B 1:1:1 ratio of packed red cells:fresh frozen plasma:platelets improves 24-hour haemostasis and 30-day survival compared to 1:1:2 ratio ✓
- C pRBC alone in the first 30 minutes, followed by FFP at 1:1 ratio after lactate >5 mmol/L
- D 1:2:1 (pRBC:FFP:platelets) with cryoprecipitate for every 10 units pRBC
Explanation
The PROPPR trial (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) — a prospective RCT of 680 severely injured patients — demonstrated that a 1:1:1 ratio of pRBC:FFP:platelets (as apheresis platelets) versus 1:1:2 resulted in significantly higher 24-hour haemostasis achievement (86% vs 78%) and improved 30-day survival trend (57% vs 50%) with more patients achieving haemostasis. The 1:1:1 ratio has become standard for massive transfusion protocols alongside tranexamic acid and permissive hypotension targeting SBP 80-90 mmHg in penetrating trauma (targeting near-normal pressure in TBI).
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.