EBQ:PROPPR Trial: Difference between revisions
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*>3 U of pRBC given before randomization | *>3 U of pRBC given before randomization | ||
==Interventions== | ==Interventions== | ||
*Two cohorts received blood product ratios of 1:1:1 (n=338) vs 1:1:2 (n=342) during active resuscitation | |||
==Outcomes== | ==Outcomes== | ||
Revision as of 12:57, 13 March 2015
incomplete Journal Club Article
Holcomb JB, Tilley BC, Baraniuk S, 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". JAMA. 2015. 313(5):471-482.
PubMed
PubMed
Clinical Question
- Compare 1:1:1 vs 1:1:2 in safety and efficacy in trauma rescus
Conclusion
- No significant differences in mortality at 24 hours or at 30 days between two groups
- More patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours (86% vs 78%; p=0.006)
- Exsanguination in first 24 hours decreased in the 1:1:1 group (9.2% vs 14.6%; p=0.03)
- No other safety differences were identified between the two groups
Major Points
- This was a negative trial - the 1:1:1 was as safe as 1:1:2
- They did not meet the 10% mortality advantage which the study was powered to but found 4.2% improvement in the 1:1:1 group at 24hr and 3.7% at 30d (not statistically significant)
Study Design
- Randomized clinical trial
Population
- 680 patients from of 12 participating level I trauma centers in North America
Patient Demographics
| Characteristics | 1:1:1 | 1:1:2 |
|---|---|---|
| Age | 34.5 (25-51) | 34 (24-50) |
| Male | 263 (77.8%) | 283 (82.7%) |
| Race - White | 210 (62.1%) | 224 (65.5%) |
| Race - Black | 94 (27.8%) | 93 (27.2%) |
| Race - Other | 35 (10.4%) | 25 (7.3%) |
Inclusion Criteria
- Highest trauma level activation
- ≥15 yo or weight ≥50 kg if age unknown
- Received directly from the injury scene
- Transfusion initiated with at least 1 U of blood component within the first hour of arrival
- Predicted to receive a massive transfusion
Exclusion Criteria
- Received a lifesaving intervention from OSH
- Terminal injuries and expected to die within 1 hour of admission (eg, lethal traumatic brain injury)
- Directly admitted from a correctional facility
- Required a thoracotomy prior to randomization
- <15 yo or <50 kg if age unknown
- Pregnant
- Burns >20% total BSA
- Suspected inhalation injury
- >5 mins of CPR
- DNR
- Enrolled in a concurrent, ongoing, interventional, randomized clinical trial
- >3 U of pRBC given before randomization
Interventions
- Two cohorts received blood product ratios of 1:1:1 (n=338) vs 1:1:2 (n=342) during active resuscitation
Outcomes
Primary Outcome
Secondary Outcomes
Subgroup analysis
Criticisms & Further Discussion
External Links
Podcast 144 – The PROPPR trial with John Holcomb