A new study, entitled “Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 ratio vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma: The PROPPR Randomized Clinical Trial” was published in JAMA by Dr. John B. Holcomb from the Center for Translational Injury Research, Division of Acute Care Surgery, at the University of Texas Health Science Center in Houston, along with colleagues.
Damage control resuscitation (DCR) consists in a transfusion with increased blood product ratios (plasma, platelets, and red blood cells), mainly given to patients that are seriously injured and experiencing hemorrhagic shock. This is a therapy that, in perfect conditions, needs the simultaneous administration of plasma, red blood cells and platelets in equal parts. The DCR is a standard procedure for combat victims that was established in the U.S. military and developed by a multidisciplinary team that included Holcomb, who was previously an Army Colonel.
In this study, the research team compared the effectiveness and safety of transfusing plasma, platelets, and red blood cells in 1:1:1 or 1:1:2 ratios, respectively in 338 and 342 patients during active resuscitation in addition to all the standard-of-care procedures (uncontrolled). This was a pragmatic, phase 3, multisite, randomized clinical trial (NCT01545232) of patients that arrived at 1 of 12 level I trauma centers in North America from a scene and needed massive transfusion. The main outcomes of this study were 24-hour and 30-day all-cause mortality, time to hemostasis, volume of blood products transfused, clinical problems, frequency of surgical procedures, and functional status.
“If I needed a massive blood transfusion, I would want damage control resuscitation,” said Dr. John B. Holcomb, principal investigator of the study, a retired U.S. Army surgeon and the director of the Division of Acute Care Surgery at the UTHealth Medical School, in the press release.
“Bleeding to death is the leading, potentially preventable cause of death in military and civilian trauma patients,” said Dr. Holcomb.
“This study represents a translation of practice from what has been learned during wartime into civilian practice after scientific evaluation. The lessons learned have definitely changed practice and saved lives. Perhaps, as has been said before, this is the only good thing to come out of war,” said David Hoyt, M.D., who is with the Resuscitation Outcomes Consortium and is the executive director of the American College of Surgeons.
Dr. Holcomb highlighted that this study was relevant to confirm the previous reports stating the benefits of damage control resuscitation.