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The PROPPR randomized clinical trial compared two transfusion strategies for patients with severe trauma and major haemorrhage: a 1:1:1 ratio of plasma, platelets and red blood cells versus a 1:1:2 ratio. The study addressed the practical challenge of how best to balance blood components during early resuscitation. The trial did not demonstrate a significant difference in overall mortality between the two groups, but the 1:1:1 strategy achieved better haemostatic outcomes, including more effective control of exsanguination and improved achievement of haemostasis in the early period. For surgeons, PROPPR is a reminder that trauma resuscitation is about more than simply replacing circulating volume. Balanced blood-component resuscitation can influence the ability to control bleeding while definitive haemorrhage control is pursued. The study also demonstrates why transfusion protocols need to be standardized before the emergency occurs. Rapid access to blood components, coordination with the operating theatre and trauma team, and clear activation pathways are critical to translating trial evidence into practice. PROPPR therefore remains highly relevant to trauma systems, particularly when designing massive transfusion protocols and training teams to respond consistently under pressure.
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The PROPPR randomized clinical trial compared two transfusion strategies for patients with severe trauma and major haemorrhage: a 1:1:1 ratio of plasma, platelets and red blood cells versus a 1:1:2 ratio. The study addressed the practical challenge of how best to balance blood components during early resuscitation. The trial did not demonstrate a significant difference in overall mortality between the two groups, but the 1:1:1 strategy achieved better haemostatic outcomes, including more effective control of exsanguination and improved achievement of haemostasis in the early period. For surgeons, PROPPR is a reminder that trauma resuscitation is about more than simply replacing circulating volume. Balanced blood-component resuscitation can influence the ability to control bleeding while definitive haemorrhage control is pursued. The study also demonstrates why transfusion protocols need to be standardized before the emergency occurs. Rapid access to blood components, coordination with the operating theatre and trauma team, and clear activation pathways are critical to translating trial evidence into practice. PROPPR therefore remains highly relevant to trauma systems, particularly when designing massive transfusion protocols and training teams to respond consistently under pressure.
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