In the management of hemorrhagic shock following blunt abdominal trauma, 'damage control resuscitation' (DCR) is initiated. Which resuscitation ratio is recommended by the PROPPR trial for packed red blood cells (pRBC): fresh frozen plasma (FFP): platelets?

• A 6:1:1
• B 1:1:1 ✓
• C 3:1:0 (no platelets until count <50,000)
• D 2:1:1

Explanation

The PROPPR (Pragmatic Randomized Optimal Platelet and Plasma Ratios) trial randomized massively transfused trauma patients to either 1:1:1 (pRBC:FFP:platelets in apheresis units) or 1:1:2 ratio. The 1:1:1 group had significantly more patients achieving hemostasis (86% vs 78%), less 24-hour mortality (9.2% vs 12.7%), and no increase in adverse events. This established 1:1:1 as the standard ratio for damage control resuscitation in massive hemorrhage. The goal is to replenish all coagulation factors early to prevent the lethal triad of acidosis, hypothermia, and coagulopathy. Tranexamic acid should be given within 3 hours of injury (CRASH-2 trial).

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.