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