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

Summary by Wana Mathieu MD, 11.26.22
https://jamanetwork.com/journals/jama/fullarticle/2107789


Take Home Messages:

  • For patients with severe trauma or major bleeding, early massive transfusion with 1:1:1 Plasma: Platelets: Red Blood Cells when compared to transfusion 1:1:2 achieved:

    • Hemostasis quicker

    • Decreased death due to exsanguination by 24 hours

  • No significant difference in overall 24-hour or 30-day mortality between groups

  • Even though there was increased use of plasma and platelets transfused in the 1:1:1 group, there were no increased complications identified between the 2 groups.

 

Summary 

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 Pragmatic, Randomized Optimal Platelet and Plasma ratio (PROPPR) Randomized Clinical Trial 

Background: 
Damage control resuscitation is defined as rapid hemorrhage control through early administration of blood products in a balanced ratio, prevention and immediate correction of coagulopathy, and minimization of crystalloid fluid. The PROPPR trial was designed to address the effectiveness and safety of a 1:1:1 transfusion ratio compared with a 1:1:2 transfusion ratio in trauma patients predicted to receive a massive transfusion 

 Methods: 
Pragmatic, phase 3, multisite, randomized trial where blood products were transfused in a prespecific order to 680 severely injured patients from one of the 12 enrolling level I trauma centers. Primary outcomes included 24hr and 30 day mortality with secondary outcomes such as time to hemostasis

 Results: 
No differences were detected between treatment groups in baseline characteristics.  Exsanguination within the first 24hrs was decreased in the 1:1:1 group. More patients achieved anatomic hemostasis in the 1:1:1 group. Patients in the 1:1:1 group received fewer blood products during the post-intervention period. There was no difference in any of the 23 complications at 30 days. 

 Discussion:
Data support the early use of 1:1:1 transfusion ratio in patients with rapid bleeding as more patients achieved hemostasis and fewer experienced death due to exsanguination by 24hrs. However, there were no significant differences in mortality at 24hrs or at 30 days.