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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.

Methodology Score: 4/5                 
Usefulness Score:  3.5/5

Holcomb JB, Tilley BC, Baraniuk S, et al.
JAMA. 2015 Feb 3;313(5):471-82.


This prospective multicenter randomized control trial found that there was no statistically significant difference in mortality at 24h and 30d between trauma patients requiring massive transfusion following a 1:1:1 platelets:plasma:rbc vs 1:1:2, however there was a decrease in exsanguination in the 1:1:1 group who also received platelets earlier.  The variation of multiple factors (order and timing of transfusion as well as ratio of blood products) between the intervention and the control group make the results difficult to interpret and JC attendees were split as to whether they would recommend a strict 1:1:1 transfusion protocol based on these results;  most would consider giving platelets earlier. 
By: Dr. Valerie Charbonneau
(Presented May 2015) 


Epi lesson:
Explanatory versus Pragmatic Clinical Trials  
Trials of healthcare interventions are often described as either explanatory or pragmatic. Explanatory trials generally measure efficacy - the benefit a treatment produces under ideal conditions, often using carefully defined subjects in a research clinic. Pragmatic trials measure effectiveness - the benefit the treatment produces in routine clinical practice. Pragmatic trials generally reflect the reality of how the intervention will perform in everyday care. For more, see http://www.bmj.com/content/316/7127/285.full
By: Dr. Ian Stiell

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