A polytrauma patient is in hemorrhagic shock after a high-speed motor vehicle accident. FAST exam shows free fluid in Morrison's pouch. The patient remains hemodynamically unstable after 2 units of packed red blood cells and 1 L of crystalloid. According to current ATLS and damage control resuscitation principles, the optimal blood product ratio for massive transfusion should approximate:
- A PRBC:FFP:Platelets = 1:1:1 ✓
- B PRBC:FFP:Platelets = 4:2:1
- C PRBC:FFP only; platelets added after >10 units PRBC
- D Crystalloid 3:1 replacement with PRBC added for Hb <7 g/dL
Correct answer: A. PRBC:FFP:Platelets = 1:1:1
Explanation
The PROPPR trial (Holcomb et al., JAMA 2015) confirmed that a 1:1:1 ratio of packed red blood cells:fresh frozen plasma:platelets for massive transfusion reduces 24-hour and 30-day mortality in hemorrhagic shock compared to 1:1:2 ratios. This balanced hemostatic resuscitation ('damage control resuscitation') mimics whole blood, prevents dilutional coagulopathy, and reduces acidosis. Crystalloid use should be minimized as it worsens the 'lethal triad' (hypothermia, acidosis, coagulopathy). ATLS 10th edition incorporated these principles.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.