More patients in the 1:1:1 group achieved hemostasis than in the 1:1:2 group (86% vs 78%, respectively P = .006). ![]() 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% P = .03). 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% P = .12) or at 30 days (22.4% vs 26.1%, respectively difference, −3.7% P = .26). Prespecified ancillary outcomes included time to hemostasis, blood product volumes transfused, complications, incidence of surgical procedures, and functional status. Main Outcomes and Measures Primary outcomes were 24-hour and 30-day all-cause mortality. 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). ![]() 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.ĭesign, 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. 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. Importance Severely injured patients experiencing hemorrhagic shock often require massive transfusion.
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