Damage control resuscitation (DCR) in massive haemorrhage has replaced traditional crystalloid-heavy resuscitation. What is the recommended ratio of packed red cells to fresh frozen plasma to platelets in DCR?

• A 4:2:1 (RBC:FFP:Platelets)
• B 1:1:1 (RBC:FFP:Platelets) ✓
• C 6:1:1 (RBC:FFP:Platelets)
• D 2:1:0.5 (RBC:FFP:Platelets)

Explanation

Damage control resuscitation uses a balanced 1:1:1 ratio of packed red blood cells:fresh frozen plasma:platelets to approximate whole blood composition, minimise dilutional coagulopathy, and reverse the lethal triad of acidosis, hypothermia, and coagulopathy. This replaced traditional high-volume crystalloid resuscitation which dilutes clotting factors. The PROPPR trial (2015) confirmed that 1:1:1 improved 24-hour and 30-day survival compared to 1:1:2. Permissive hypotension (target MAP 50 mmHg or systolic 80-90 mmHg) is also practised until haemorrhage control.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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