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
John B. Holcomb,Barbara C. Tilley,Sarah Baraniuk,Erin E. Fox,Charles E. Wade,Jeanette M. Podbielski,Deborah J. del Junco,Karen J. Brasel,Karen J. Brasel,Eileen M. Bulger,Rachael A. Callcut,Mitchell J. Cohen,Bryan A. Cotton,Timothy C. Fabian,Kenji Inaba,Jeffrey D. Kerby,Peter Muskat,Peter Muskat,Terence O'Keeffe,Sandro Rizoli,Bryce R.H. Robinson,Thomas M. Scalea,Martin A. Schreiber,Deborah M. Stein,Jordan A. Weinberg,Jeannie Callum,John R. Hess,Nena Matijevic,Christopher N. Miller,Jean-Francois Pittet,David B. Hoyt,Gail D. Pearson,Brian G. Leroux,Gerald van Belle +33 more
TLDR
In this article, the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1 :1:2 ratio was evaluated.Abstract:
Importance Severely injured patients experiencing hemorrhagic shock often require massive transfusion. Earlier transfusion with higher blood product ratios (plasma, platelets, and red blood cells), defined as damage control resuscitation, has been associated with improved outcomes; however, there have been no large multicenter clinical trials. Objective To determine the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio. Design, Setting, and Participants Pragmatic, phase 3, multisite, randomized clinical trial of 680 severely injured patients who arrived at 1 of 12 level I trauma centers in North America directly from the scene and were predicted to require massive transfusion between August 2012 and December 2013. Interventions Blood product ratios of 1:1:1 (338 patients) vs 1:1:2 (342 patients) during active resuscitation in addition to all local standard-of-care interventions (uncontrolled). Main Outcomes and Measures Primary outcomes were 24-hour and 30-day all-cause mortality. Prespecified ancillary outcomes included time to hemostasis, blood product volumes transfused, complications, incidence of surgical procedures, and functional status. Results No significant differences were detected in mortality at 24 hours (12.7% in 1:1:1 group vs 17.0% in 1:1:2 group; difference, −4.2% [95% CI, −9.6% to 1.1%]; P = .12) or at 30 days (22.4% vs 26.1%, respectively; difference, −3.7% [95% CI, −10.2% to 2.7%]; P = .26). Exsanguination, which was the predominant cause of death within the first 24 hours, was significantly decreased in the 1:1:1 group (9.2% vs 14.6% in 1:1:2 group; difference, −5.4% [95% CI, −10.4% to −0.5%]; P = .03). More patients in the 1:1:1 group achieved hemostasis than in the 1:1:2 group (86% vs 78%, respectively; P = .006). Despite the 1:1:1 group receiving more plasma (median of 7 U vs 5 U, P P Conclusions and Relevance Among patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days. However, more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours. Even though there was an increased use of plasma and platelets transfused in the 1:1:1 group, no other safety differences were identified between the 2 groups. Trial Registration clinicaltrials.gov Identifier:NCT01545232read more
Citations
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The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition
Rolf Rossaint,Bertil Bouillon,Vladimir Cerny,Timothy J Coats,Jacques Duranteau,Enrique Fernández-Mondéjar,Daniela Filipescu,Beverley J. Hunt,Radko Komadina,Giuseppe Nardi,Edmund Neugebauer,Yves Ozier,Louis Riddez,Arthur Schultz,Jean Louis Vincent,Donat R. Spahn +15 more
TL;DR: The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation, and may also serve as a basis for local implementation.
Journal ArticleDOI
European Resuscitation Council Guidelines for Resuscitation 2015
Gavin D. Perkins,Gavin D. Perkins,Anthony J. Handley,Rudolph W. Koster,Maaret Castrén,Michael Smyth,Theresa M. Olasveengen,Koenraad G. Monsieurs,Koenraad G. Monsieurs,Violetta Raffay,Jan-Thorsten Gräsner,Volker Wenzel,Giuseppe Ristagno,Jasmeet Soar,Leo Bossaert,Antonio Caballero,Pascal Cassan,Cristina Granja,Claudio Sandroni,David Zideman,Jerry P. Nolan,Ian Maconochie,Robert Greif +22 more
TL;DR: This chapter contains guidance on the techniques used during the initial resuscitation of an adult cardiac arrest victim and the use of an automated external defibrillator (AED).
Journal ArticleDOI
European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances
Anatolij Truhlář,Charles D. Deakin,Jasmeet Soar,Gamal Eldin Abbas Khalifa,A. Alfonzo,Joost J.L.M. Bierens,Guttorm Brattebø,Hermann Brugger,Joel Dunning,Silvija Hunyadi-Anticevic,Rudolph W. Koster,David Lockey,Carsten Lott,Peter Paal,Gavin D. Perkins,Claudio Sandroni,Karl-Christian Thies,David Zideman,Jerry P. Nolan +18 more
TL;DR: The guidelines for resuscitation in special circumstances section Collaborators1 are published on behalf of the Cardiac arrest in special ircumstances section Collaborator1.
Journal ArticleDOI
Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock.
Jason L. Sperry,Francis X. Guyette,Joshua B. Brown,Mark H. Yazer,Darrell J. Triulzi,Barbara J. Early-Young,Peter W. Adams,Brian J. Daley,Richard S. Miller,Brian G. Harbrecht,Jeffrey A. Claridge,Herb A. Phelan,William R. Witham,A. Tyler Putnam,Therese M. Duane,Louis H. Alarcon,Clifton W. Callaway,Brian S. Zuckerbraun,Matthew D. Neal,Matthew R. Rosengart,Raquel M. Forsythe,Timothy R. Billiar,Donald M. Yealy,Andrew B. Peitzman,Mazen S. Zenati +24 more
TL;DR: In injured patients at risk for hemorrhagic shock, the prehospital administration of thawed plasma was safe and resulted in lower 30‐day mortality and a lower median prothrombin‐time ratio than standard‐care resuscitation.
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The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital
Matthew A. Borgman,Philip C. Spinella,Jeremy G. Perkins,Kurt W. Grathwohl,Thomas Repine,Alec C. Beekley,James A. Sebesta,Donald H. Jenkins,Charles E. Wade,John B. Holcomb +9 more
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Damage control resuscitation: Directly addressing the early coagulopathy of trauma
John B. Holcomb,Donald H. Jenkins,Peter Rhee,Jay A. Johannigman,Peter F. Mahoney,Sumeru G. Mehta,E. Darrin Cox,Michael J. Gehrke,Gregory J. Beilman,Martin A. Schreiber,Stephen F. Flaherty,Kurt W. Grathwohl,Phillip C. Spinella,Jeremy G. Perkins,Alec C. Beekley,Neil R. McMullin,Myung S. Park,Ernest A. Gonzalez,Charles E. Wade,Michael A. Dubick,C. William Schwab,Frederick A. Moore,Howard R. Champion,David B. Hoyt,John R. Hess +24 more
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