A 30-year-old male motorcyclist arrives 45 minutes after a road traffic accident. BP 80/50 mmHg, HR 130/min, GCS 12. FAST ultrasound shows free fluid in the peritoneum. A massive transfusion protocol (MTP) is activated. Which ratio of packed red blood cells (PRBCs) to fresh frozen plasma (FFP) to platelets has been shown to improve 24-hour and 30-day mortality in the PROPPR trial?
- A 10:4:1 (PRBCs:FFP:platelets)
- B 2:1:1 (PRBCs:FFP:platelets)
- C 3:1:0 (PRBCs:FFP without platelets initially)
- D 1:1:1 (PRBCs:FFP:platelets) ✓
Explanation
The PROPPR trial (Pragmatic Randomised Optimal Platelet and Plasma Ratios, JAMA 2015) was a landmark RCT that compared 1:1:1 versus 1:1:2 (plasma:platelets:RBC) transfusion ratios in severely injured haemorrhaging trauma patients. The 1:1:1 ratio achieved more frequent haemostasis (86% vs 78%) and significantly reduced 24-hour mortality, without increasing complications. This supports damage control resuscitation principles (early balanced resuscitation with empiric FFP and platelets). The 2:1:1 ratio approximates the older practice. The PROPPR trial's 1:1:1 finding is now embedded in ATLS 10th edition damage control resuscitation guidelines.
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.