A polytrauma patient is being managed with damage control resuscitation (DCR). Which combination constitutes the TARGET ratio for massive transfusion protocol (MTP) as supported by the PROPPR trial?
- A 4:2:1 ratio — packed RBC:FFP:platelets
- B 6:4:1 ratio — packed RBC:FFP:platelets
- C 1:1:1 ratio — packed RBC:FFP:platelets ✓
- D 2:1:1 ratio — packed RBC:FFP:platelets
Explanation
The PROPPR (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) trial (JAMA 2015) compared 1:1:1 versus 1:1:2 (RBC:FFP:platelet) ratios in massively bleeding trauma patients. The 1:1:1 ratio group had significantly improved hemostasis at 24 hours and reduced 24-hour mortality (12.7% vs 17%), though 30-day mortality was not significantly different. The trial supported adoption of a 1:1:1 ratio (packed RBC:FFP:platelets) as the preferred MTP strategy in hemorrhagic shock. This reflects a whole blood-equivalent approach, replacing traumatic coagulopathy and dilutional coagulopathy. The 4:2:1 is older standard and associated with worse coagulopathy outcomes in major trauma.
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.