A trauma patient in hemorrhagic shock is being transfused using massive transfusion protocol (MTP). According to current evidence-based guidelines, what is the optimal ratio of packed red blood cells (pRBC) : fresh frozen plasma (FFP) : platelets?

• A 6:1:1
• B 1:1:1 ✓
• C 3:1:1
• D 4:2:1

Explanation

The PROPPR trial (2015) demonstrated that a 1:1:1 ratio of pRBC:FFP:platelets in massive transfusion achieves hemostasis faster and reduces 24-hour mortality compared to a 1:1:2 ratio. This balanced resuscitation approach mimics whole blood transfusion and prevents the lethal triad of hypothermia, acidosis, and coagulopathy in trauma. Tranexamic acid (TXA) given within 3 hours of injury (CRASH-2 trial) is also an important adjunct. Damage control resuscitation with permissive hypotension (target systolic 80-90 mmHg until hemorrhage control) is practiced alongside this balanced ratio.

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.