EBQ:PROPPR Trial

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

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

Study Design

Randomized clinical trial

Population

680 patients from of 12 participating level I trauma centers in North America

Patient Demographics

Characteristic	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