PROPPR Transfusion Ratio for Trauma Patients
Rapid transfusion of blood for severely bleeding trauma patients is critical. However, the optimal ratio of plasma to platelets to red blood cells has not been determined.
The PROPPR randomized clinical trial examined mortality and exsanguination in 680 severely injured patients at level one trauma centers in North America (Holcomb JB et al. JAMA 2015:313:471-82). In the study, 338 patients received a 1:1:1 ratio of plasma, platelets and red blood cells, while the other 342 patients received a 1:1:2 ratio. Similar quantities of red blood cells were transfused in both groups, but the group randomized to the 1:1:2 ratio received half the amount of plasma and platelets as the group randomized to the 1:1:1 ratio.
There was no difference in outcome at 24 hours and 30 days between the two groups. However, the number of patients who died from exsanguination within the first 24 hours was significantly decreased in the 1:1:1 group.
Rapid transfusion of a 1:1:1 ratio of plasma, platelets and red blood cells was associated with improved early survival in patients who were bleeding to death. The results from this study suggest that a 1:1:1 ratio of plasma, platelets and red blood cells is best for achieving hemostasis in severely bleeding trauma patients.
