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

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. 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.


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


  1. Holcomb JB et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA 2015 Feb 3313:471.
Read all articles in Endotracheal Intubation, medical procedures, Traumatology
Tags: HPC updates, massive transfusion protocol, transfusions, trauma

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