A ‘PROPPR’ Answer to the Transfusion Ration Dilemma

Hemorrhage and exsanguination remains a leading but preventable cause of death after trauma. The early correction of trauma-induced coagulopathy is a key component of damage-control resuscitation (DCR), which is a concept that emerged from military practice almost a decade ago and was instantly adopted by major trauma centers in North America.¹  DCR calls for delayed resuscitation primarily with blood products and relies on a high ratio of fresh frozen plasma (FFP) and platelets (PLTs) to packed red cells (PRBCs). In so doing, this strategy aims to reconstitute a whole blood milieu. Numerous anecdotal reports from the battle-field followed by a barrage of retrospective studies demonstrated the lifesaving effects of this strategy in both military and civilian settings. This data profoundly changed transfusion practice through the introduction of institutional massive transfusion protocols (MTPs), which are designed for the rapid...