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Comment & Response |

Mortality and Ratio of Blood Products Used in Patients With Severe Trauma

Michael T. McCurdy, MD1; Alyson Liew-Spilger, BS2; Mark Walsh, MD3
[+] Author Affiliations
1Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore
2Department of Medical Education, Memorial Hospital of South Bend, South Bend, Indiana
3Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
JAMA. 2015;313(20):2077-2078. doi:10.1001/jama.2015.4421.
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To the Editor The PROPPR trial1 confirmed the safety of a 1:1:1 ratio for units of plasma and platelets to RBCs for patients with severe trauma requiring massive transfusion compared with a 1:1:2 ratio. We have 3 questions about the study.

First, the definition of massive transfusion varies, yet the authors chose to define it as 10 U of RBCs transfused over 24 hours. Even though the 1:1:1 ratio led to early hemostasis and reduced death by exsanguination, the trial’s definition of massive transfusion may have reduced its reported efficacy.2 Lifesaving massive transfusion is often given within the first few hours of resuscitation, but many study patients received blood during the catch-up phase (hours 6 to 24). We question whether a subgroup analysis of only those who received 10 U of RBCs within the first 6 hours would reveal a shorter time to hemostasis and a greater mortality reduction from exsanguination.

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May 26, 2015
John B. Holcomb, MD; Erin E. Fox, PhD; Charles E. Wade, PhD; for the PROPPR Study Group
1Center for Translational Injury Research, University of Texas Health Science Center, Houston
JAMA. 2015;313(20):2078-2079. doi:10.1001/jama.2015.4427.
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