Damage Control Resuscitation and Emergency Laparotomy: Findings from the PROPPR Study

on behalf of the PROPPR Study Group

    Research output: Contribution to journalArticle

    18 Citations (Scopus)

    Abstract

    BACKGROUND: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial has demonstrated that damage control resuscitation, a massive transfusion strategy targeting a balanced delivery of plasma-platelet-RBC in a ratio of 1:1:1, results in improved survival at 3 hours and a reduction in deaths due to exsanguination in the first 24 hours compared to a 1:1:2 ratio. In light of these findings, we hypothesized that patients receiving 1:1:1 ratio would have improved survival after emergency laparotomy. METHODS: Severely injured patients predicted to receive a massive transfusion admitted to 12 level I North American trauma centers were randomized to 1:1:1 versus 1:1:2 as described in the PROPPR trial. From these patients, the subset that underwent an emergency laparotomy, defined previously in the literature as laparotomy within 90 minutes of arrival, were identified. We compared rates and timing of emergency laparotomy as well as post-surgical survival at 24-hours and 30-days. RESULTS: Of the 680 enrolled patients, 613 underwent a surgical procedure, 397 underwent a laparotomy, and 346 underwent an emergency laparotomy. The percentages of patients undergoing emergency laparotomy were 51.5% (174/338) and 50.3% (172/342) for 1:1:1 and 1:1:2, respectively (p=0.20). Median time to laparotomy was 28 minutes in both treatment groups. Among patients undergoing an emergency laparotomy, the proportions of patients surviving to 24 hours and 30 days were similar between treatment arms, 24-hour survival was 86.8% (151/174) for 1:1:1 and 83.1% (143/172) for 1:1:2 (p=0.29), and 30-day 79.3% (138/174) for 1:1:1 and 75.0% (129/172) for 1:1:2 (p=0.30). CONCLUSIONS: We found no evidence that resuscitation strategy affects whether a patient requires an emergency laparotomy, time to laparotomy, or subsequent survival. LEVEL OF EVIDENCE: Level IV, therapeutic study.

    Original languageEnglish (US)
    JournalJournal of Trauma and Acute Care Surgery
    DOIs
    StateAccepted/In press - Jan 21 2016

    Fingerprint

    Resuscitation
    Laparotomy
    Emergencies
    Blood Platelets
    Survival
    Exsanguination
    Trauma Centers
    Therapeutics

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Damage Control Resuscitation and Emergency Laparotomy : Findings from the PROPPR Study. / on behalf of the PROPPR Study Group.

    In: Journal of Trauma and Acute Care Surgery, 21.01.2016.

    Research output: Contribution to journalArticle

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    title = "Damage Control Resuscitation and Emergency Laparotomy: Findings from the PROPPR Study",
    abstract = "BACKGROUND: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial has demonstrated that damage control resuscitation, a massive transfusion strategy targeting a balanced delivery of plasma-platelet-RBC in a ratio of 1:1:1, results in improved survival at 3 hours and a reduction in deaths due to exsanguination in the first 24 hours compared to a 1:1:2 ratio. In light of these findings, we hypothesized that patients receiving 1:1:1 ratio would have improved survival after emergency laparotomy. METHODS: Severely injured patients predicted to receive a massive transfusion admitted to 12 level I North American trauma centers were randomized to 1:1:1 versus 1:1:2 as described in the PROPPR trial. From these patients, the subset that underwent an emergency laparotomy, defined previously in the literature as laparotomy within 90 minutes of arrival, were identified. We compared rates and timing of emergency laparotomy as well as post-surgical survival at 24-hours and 30-days. RESULTS: Of the 680 enrolled patients, 613 underwent a surgical procedure, 397 underwent a laparotomy, and 346 underwent an emergency laparotomy. The percentages of patients undergoing emergency laparotomy were 51.5{\%} (174/338) and 50.3{\%} (172/342) for 1:1:1 and 1:1:2, respectively (p=0.20). Median time to laparotomy was 28 minutes in both treatment groups. Among patients undergoing an emergency laparotomy, the proportions of patients surviving to 24 hours and 30 days were similar between treatment arms, 24-hour survival was 86.8{\%} (151/174) for 1:1:1 and 83.1{\%} (143/172) for 1:1:2 (p=0.29), and 30-day 79.3{\%} (138/174) for 1:1:1 and 75.0{\%} (129/172) for 1:1:2 (p=0.30). CONCLUSIONS: We found no evidence that resuscitation strategy affects whether a patient requires an emergency laparotomy, time to laparotomy, or subsequent survival. LEVEL OF EVIDENCE: Level IV, therapeutic study.",
    author = "{on behalf of the PROPPR Study Group} and {Undurraga Perl}, {Vicente J.} and Brian Leroux and Cook, {Mackenzie R.} and Justin Watson and Kelly Fair and Martin, {David T.} and Kerby, {Jeffrey D.} and Carolyn Williams and Kenji Inaba and Wade, {Charles E.} and Cotton, {Bryan A.} and {Del Junco}, {Deborah J J} and Fox, {Erin E.} and Scalea, {Thomas M.} and Tilley, {Barbara C.} and Holcomb, {John B.} and Martin Schreiber",
    year = "2016",
    month = "1",
    day = "21",
    doi = "10.1097/TA.0000000000000960",
    language = "English (US)",
    journal = "Journal of Trauma and Acute Care Surgery",
    issn = "2163-0755",
    publisher = "Lippincott Williams and Wilkins",

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    T1 - Damage Control Resuscitation and Emergency Laparotomy

    T2 - Findings from the PROPPR Study

    AU - on behalf of the PROPPR Study Group

    AU - Undurraga Perl, Vicente J.

    AU - Leroux, Brian

    AU - Cook, Mackenzie R.

    AU - Watson, Justin

    AU - Fair, Kelly

    AU - Martin, David T.

    AU - Kerby, Jeffrey D.

    AU - Williams, Carolyn

    AU - Inaba, Kenji

    AU - Wade, Charles E.

    AU - Cotton, Bryan A.

    AU - Del Junco, Deborah J J

    AU - Fox, Erin E.

    AU - Scalea, Thomas M.

    AU - Tilley, Barbara C.

    AU - Holcomb, John B.

    AU - Schreiber, Martin

    PY - 2016/1/21

    Y1 - 2016/1/21

    N2 - BACKGROUND: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial has demonstrated that damage control resuscitation, a massive transfusion strategy targeting a balanced delivery of plasma-platelet-RBC in a ratio of 1:1:1, results in improved survival at 3 hours and a reduction in deaths due to exsanguination in the first 24 hours compared to a 1:1:2 ratio. In light of these findings, we hypothesized that patients receiving 1:1:1 ratio would have improved survival after emergency laparotomy. METHODS: Severely injured patients predicted to receive a massive transfusion admitted to 12 level I North American trauma centers were randomized to 1:1:1 versus 1:1:2 as described in the PROPPR trial. From these patients, the subset that underwent an emergency laparotomy, defined previously in the literature as laparotomy within 90 minutes of arrival, were identified. We compared rates and timing of emergency laparotomy as well as post-surgical survival at 24-hours and 30-days. RESULTS: Of the 680 enrolled patients, 613 underwent a surgical procedure, 397 underwent a laparotomy, and 346 underwent an emergency laparotomy. The percentages of patients undergoing emergency laparotomy were 51.5% (174/338) and 50.3% (172/342) for 1:1:1 and 1:1:2, respectively (p=0.20). Median time to laparotomy was 28 minutes in both treatment groups. Among patients undergoing an emergency laparotomy, the proportions of patients surviving to 24 hours and 30 days were similar between treatment arms, 24-hour survival was 86.8% (151/174) for 1:1:1 and 83.1% (143/172) for 1:1:2 (p=0.29), and 30-day 79.3% (138/174) for 1:1:1 and 75.0% (129/172) for 1:1:2 (p=0.30). CONCLUSIONS: We found no evidence that resuscitation strategy affects whether a patient requires an emergency laparotomy, time to laparotomy, or subsequent survival. LEVEL OF EVIDENCE: Level IV, therapeutic study.

    AB - BACKGROUND: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial has demonstrated that damage control resuscitation, a massive transfusion strategy targeting a balanced delivery of plasma-platelet-RBC in a ratio of 1:1:1, results in improved survival at 3 hours and a reduction in deaths due to exsanguination in the first 24 hours compared to a 1:1:2 ratio. In light of these findings, we hypothesized that patients receiving 1:1:1 ratio would have improved survival after emergency laparotomy. METHODS: Severely injured patients predicted to receive a massive transfusion admitted to 12 level I North American trauma centers were randomized to 1:1:1 versus 1:1:2 as described in the PROPPR trial. From these patients, the subset that underwent an emergency laparotomy, defined previously in the literature as laparotomy within 90 minutes of arrival, were identified. We compared rates and timing of emergency laparotomy as well as post-surgical survival at 24-hours and 30-days. RESULTS: Of the 680 enrolled patients, 613 underwent a surgical procedure, 397 underwent a laparotomy, and 346 underwent an emergency laparotomy. The percentages of patients undergoing emergency laparotomy were 51.5% (174/338) and 50.3% (172/342) for 1:1:1 and 1:1:2, respectively (p=0.20). Median time to laparotomy was 28 minutes in both treatment groups. Among patients undergoing an emergency laparotomy, the proportions of patients surviving to 24 hours and 30 days were similar between treatment arms, 24-hour survival was 86.8% (151/174) for 1:1:1 and 83.1% (143/172) for 1:1:2 (p=0.29), and 30-day 79.3% (138/174) for 1:1:1 and 75.0% (129/172) for 1:1:2 (p=0.30). CONCLUSIONS: We found no evidence that resuscitation strategy affects whether a patient requires an emergency laparotomy, time to laparotomy, or subsequent survival. LEVEL OF EVIDENCE: Level IV, therapeutic study.

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