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The PROPPR randomised clinical trial evaluated two massive-transfusion strategies in severely injured patients with major bleeding: a 1:1:1 ratio of plasma, platelets and red blood cells versus a 1:1:2 ratio. The study enrolled 680 patients at 12 North American level I trauma centres and addressed a central question in damage-control resuscitation: whether earlier balanced blood-component delivery improves outcomes. The trial did not demonstrate a statistically significant reduction in mortality at 24 hours or 30 days. However, the 1:1:1 strategy reduced death from exsanguination in the first 24 hours and increased the proportion of patients who achieved haemostasis. Importantly, it did not produce a significant increase in the prespecified complications measured in the trial. For HCPs, the practical message is that transfusion strategy should be judged on more than overall mortality. In actively bleeding trauma, rapid haemorrhage control and timely balanced component therapy may improve the ability to achieve haemostasis, while decisions must still account for available products, viscoelastic testing, surgical control and local protocols. The study fits CritiCARE's trauma sessions on coagulopathy, haemorrhage control and viscoelastic point-of-care testing.
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The PROPPR randomised clinical trial evaluated two massive-transfusion strategies in severely injured patients with major bleeding: a 1:1:1 ratio of plasma, platelets and red blood cells versus a 1:1:2 ratio. The study enrolled 680 patients at 12 North American level I trauma centres and addressed a central question in damage-control resuscitation: whether earlier balanced blood-component delivery improves outcomes. The trial did not demonstrate a statistically significant reduction in mortality at 24 hours or 30 days. However, the 1:1:1 strategy reduced death from exsanguination in the first 24 hours and increased the proportion of patients who achieved haemostasis. Importantly, it did not produce a significant increase in the prespecified complications measured in the trial. For HCPs, the practical message is that transfusion strategy should be judged on more than overall mortality. In actively bleeding trauma, rapid haemorrhage control and timely balanced component therapy may improve the ability to achieve haemostasis, while decisions must still account for available products, viscoelastic testing, surgical control and local protocols. The study fits CritiCARE's trauma sessions on coagulopathy, haemorrhage control and viscoelastic point-of-care testing.
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