Transfuse Plasma, Platelets, and Red Blood Cells in a 1:1:1 Ratio in Trauma

Authors: Holcomb JB et al. JAMA 2015 Feb 3.

Compared with a 1:1:2 ratio, the 1:1:1 ratio improved hemostasis without causing more adverse effects, although mortality did not differ.

In recent years, the dogma regarding large-volume crystalloid resuscitation in trauma patients has changed, with increased emphasis on including plasma and platelets in addition to red blood cells in the immediate resuscitation protocol (NEJM JW Emerg Med May 8 2009 and NEJM JW Emerg Med Oct 8 2014). The long-awaited PROPPR trial compared the safety and efficacy of transfusion of plasma, platelets, and red blood cells in a 1:1:1 ratio versus a 1:1:2 ratio in 680 severely injured patients presenting to 12 North American trauma centers.

Mortality at 24 hours and 30 days (the primary outcomes) did not differ significantly between the 1:1:1 group and the 1:1:2 group (13% and 17% at 24 hours; 22% and 26% at 30 days). Significantly fewer patients in the 1:1:1 group exsanguinated (9.2% vs. 14.6%) and significantly more patients in the 1:1:1 group achieved hemostasis (86% vs. 78%). There were no significant differences between groups in incidence of acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, transfusion-related complications, or other adverse effects.

COMMENT
Trauma patients requiring transfusion should receive plasma, platelets, and red blood cells in a 1:1:1 volume.