In damage control resuscitation for a massively bleeding trauma patient, a balanced ratio of blood products is transfused. What is the recommended ratio of fresh frozen plasma to packed red blood cells to platelets in massive transfusion protocol?

• A 2:1:1 (FFP:PRBC:Platelets)
• B 1:3:1 (FFP:PRBC:Platelets)
• C 1:2:1 (FFP:PRBC:Platelets)
• D 1:1:1 (FFP:PRBC:Platelets) ✓

Explanation

The PROPPR trial and current ATLS guidelines support a 1:1:1 ratio of FFP to platelets to PRBCs in massive transfusion for trauma patients with hemorrhagic shock. This balanced ratio approximates whole blood composition and aims to prevent the lethal triad of coagulopathy, hypothermia, and acidosis. Historically, higher PRBC ratios were used, but evidence now favors balanced resuscitation to prevent dilutional coagulopathy.

Reference: ATLS Advanced Trauma Life Support, 10th ed.

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