EBQ:PROPPR Trial - Revision history

Neil.m.young at 12:06, 4 May 2016

2016-05-04T12:06:14Z

← Revisión anterior		Revisión del 12:06 4 may 2016
Línea 140:		Línea 140:

	==External Links==		==External Links==
	[http://emcrit.org/podcasts/proppr/ Podcast 144 – The PROPPR trial with John Holcomb]		*[http://emcrit.org/podcasts/proppr/ Podcast 144 – The PROPPR trial with John Holcomb]
			*[http://emnerd.com/adventure-blanched-soldier/ EM Nerd - The Adventure of the Blanched Soldier]

	==Funding==		==Funding==

Neil.m.young at 12:05, 4 May 2016

2016-05-04T12:05:37Z

← Revisión anterior		Revisión del 12:05 4 may 2016
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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	*This was ultimately an unblinded and was a negative primary outcome due to the powering to detect only an absolute difference of 10% in mortality. To reach statistical significance for a small effect, 2968 patients would have been required to detect the observed difference of 4.2% (24 hour mortality) with 90% power. Regardless this is the best evidence to date the 1:1:1 ratio is a safe and effective treatment. <ref>Radecki R. The Fixed-Ratio Massive Transfusion Answer. http://www.emlitofnote.com/2015/02/the-fixed-ratio-massive-transfusion.html</ref>		*This was ultimately an unblinded and was a negative primary outcome due to the powering to detect only an absolute difference of 10% in mortality. To reach statistical significance for a small effect, 2968 patients would have been required to detect the observed difference of 4.2% (24 hour mortality) with 90% power. Regardless this is the best evidence to date the 1:1:1 ratio is a safe and effective treatment. <ref>Radecki R. The Fixed-Ratio Massive Transfusion Answer. http://www.emlitofnote.com/2015/02/the-fixed-ratio-massive-transfusion.html</ref>
	*The 1:1:1 group ~~recieved~~ platelets first (six units) followed by alternating RBCs and plasma. However, the 1:1:2 group ~~recieved~~ two unis RBCs first followed by 1 unt of plasma. ~~Platents~~ were not given until the patient ~~recieved~~ 9 units of other blood products. This makes interpretation of the results unclear since ~~the~~ the platelets not the ratio may have been responsible for the early hemostasis achieved.		*The 1:1:1 group received platelets first (six units) followed by alternating RBCs and plasma. However, the 1:1:2 group received two unis RBCs first followed by 1 unt of plasma. Patients were not given until the patient received 9 units of other blood products. This makes interpretation of the results unclear since the platelets not the ratio may have been responsible for the early hemostasis achieved.
	*Study design was randomized, multi-centre, and pragmatic, with minimal loss to 30 day followup, and allocation concealed during trial duration.		*Study design was randomized, multi-centre, and pragmatic, with minimal loss to 30 day followup, and allocation concealed during trial duration.
	*Transfusion complications may be more likely related to the increased use of platelets in the treatment arm.		*Transfusion complications may be more likely related to the increased use of platelets in the treatment arm.
	*This trial did not truly compare 1:1:1 vs 1:1:2 resuscitative strategies. Rather Holcomb et al examined a protocol intending to give 1:1:1 vs 1:1:2. In reality neither group truly reached their proportional expectations. The 1:1:1 group in actuality was given products closer to a 2:1:2 ratio, while the 1:1:2 group only received products in a 2:1:4 ratio. <ref> EM Nerd. The Adventure of the Blanched Soldier. http://emnerd.com/adventure-blanched-soldier/</ref>		*This trial did not truly compare 1:1:1 vs 1:1:2 resuscitative strategies. Rather Holcomb et al examined a protocol intending to give 1:1:1 vs 1:1:2. In reality, neither group truly reached their proportional expectations. The 1:1:1 group in actuality was given products closer to a 2:1:2 ratio, while the 1:1:2 group only received products in a 2:1:4 ratio. <ref> EM Nerd. The Adventure of the Blanched Soldier. http://emnerd.com/adventure-blanched-soldier/</ref>
	*Lab guided strategies in smaller sample sizes have not demonstrated 1:1:1 to be superior<ref> Bartolomeu et al. “Effect of a Fixed-Ratio (1:1:1) Transfusion Protocol Versus Laboratory-Results–guided Transfusion in Patients with Severe Trauma: a Randomized Feasibility Trial.” CMAJ : Canadian Medical Association Journal 185.12 (2013): E583–E589. PMC. Web. 6 Feb. 2015.</ref>		*Lab guided strategies in smaller sample sizes have not demonstrated 1:1:1 to be superior<ref> Bartolomeu et al. “Effect of a Fixed-Ratio (1:1:1) Transfusion Protocol Versus Laboratory-Results–guided Transfusion in Patients with Severe Trauma: a Randomized Feasibility Trial.” CMAJ : Canadian Medical Association Journal 185.12 (2013): E583–E589. PMC. Web. 6 Feb. 2015.</ref>
	*

	==External Links==		==External Links==

Neil.m.young at 17:44, 6 March 2016

2016-03-06T17:44:47Z

← Revisión anterior		Revisión del 17:44 6 mar 2016
Línea 148:		Línea 148:
	*The Defence Research and Development Canada in partnership with the Canadian Institutes of Health Research-Institute of Circulatory and Respiratory Health (grant CRR-120612)		*The Defence Research and Development Canada in partnership with the Canadian Institutes of Health Research-Institute of Circulatory and Respiratory Health (grant CRR-120612)

	==~~Sources~~==		==References==
	<references/>		<references/>

	[[Category:EBQ]]		[[Category:EBQ]]

Alvarez13: Product protocol

2015-10-24T02:41:18Z

Product protocol

← Revisión anterior		Revisión del 02:41 24 oct 2015
Línea 30:		Línea 30:
	==Study Design==		==Study Design==
	*Randomized clinical trial		*Randomized clinical trial
			*Blood product protocol
			**1:1:1 = 6 plt, (1 RBC, 1 FFP) x 6, 6 plt...
			**1:1:2 = (2 RBC, 1 FFP) x 3, 6 plt, (2 RBC, 1 FFP) x 3, 6 plt...

	==Population==		==Population==

Ostermayer: /* Criticisms & Further Discussion */

2015-05-24T15:16:46Z

Criticisms & Further Discussion

← Revisión anterior		Revisión del 15:16 24 may 2015
Línea 130:		Línea 130:
	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	*This was ultimately an unblinded and was a negative primary outcome due to the powering to detect only an absolute difference of 10% in mortality. To reach statistical significance for a small effect, 2968 patients would have been required to detect the observed difference of 4.2% (24 hour mortality) with 90% power. Regardless this is the best evidence to date the 1:1:1 ratio is a safe and effective treatment. <ref>Radecki R. The Fixed-Ratio Massive Transfusion Answer. http://www.emlitofnote.com/2015/02/the-fixed-ratio-massive-transfusion.html</ref>		*This was ultimately an unblinded and was a negative primary outcome due to the powering to detect only an absolute difference of 10% in mortality. To reach statistical significance for a small effect, 2968 patients would have been required to detect the observed difference of 4.2% (24 hour mortality) with 90% power. Regardless this is the best evidence to date the 1:1:1 ratio is a safe and effective treatment. <ref>Radecki R. The Fixed-Ratio Massive Transfusion Answer. http://www.emlitofnote.com/2015/02/the-fixed-ratio-massive-transfusion.html</ref>
			*The 1:1:1 group recieved platelets first (six units) followed by alternating RBCs and plasma. However, the 1:1:2 group recieved two unis RBCs first followed by 1 unt of plasma. Platents were not given until the patient recieved 9 units of other blood products. This makes interpretation of the results unclear since the the platelets not the ratio may have been responsible for the early hemostasis achieved.
	*Study design was randomized, multi-centre, and pragmatic, with minimal loss to 30 day followup, and allocation concealed during trial duration.		*Study design was randomized, multi-centre, and pragmatic, with minimal loss to 30 day followup, and allocation concealed during trial duration.
	*Transfusion complications may be more likely related to the increased use of platelets in the treatment arm.		*Transfusion complications may be more likely related to the increased use of platelets in the treatment arm.
	*This trial did not truly compare 1:1:1 vs 1:1:2 resuscitative strategies. Rather Holcomb et al examined a protocol intending to give 1:1:1 vs 1:1:2. In reality neither group truly reached their proportional expectations. The 1:1:1 group in actuality was given products closer to a 2:1:2 ratio, while the 1:1:2 group only received products in a 2:1:4 ratio. <ref> EM Nerd. The Adventure of the Blanched Soldier. http://emnerd.com/adventure-blanched-soldier/</ref>		*This trial did not truly compare 1:1:1 vs 1:1:2 resuscitative strategies. Rather Holcomb et al examined a protocol intending to give 1:1:1 vs 1:1:2. In reality neither group truly reached their proportional expectations. The 1:1:1 group in actuality was given products closer to a 2:1:2 ratio, while the 1:1:2 group only received products in a 2:1:4 ratio. <ref> EM Nerd. The Adventure of the Blanched Soldier. http://emnerd.com/adventure-blanched-soldier/</ref>
	*Lab guided strategies in smaller sample sizes have not demonstrated 1:1:1 to be superior<ref> Bartolomeu et al. “Effect of a Fixed-Ratio (1:1:1) Transfusion Protocol Versus Laboratory-Results–guided Transfusion in Patients with Severe Trauma: a Randomized Feasibility Trial.” CMAJ : Canadian Medical Association Journal 185.12 (2013): E583–E589. PMC. Web. 6 Feb. 2015.</ref>		*Lab guided strategies in smaller sample sizes have not demonstrated 1:1:1 to be superior<ref> Bartolomeu et al. “Effect of a Fixed-Ratio (1:1:1) Transfusion Protocol Versus Laboratory-Results–guided Transfusion in Patients with Severe Trauma: a Randomized Feasibility Trial.” CMAJ : Canadian Medical Association Journal 185.12 (2013): E583–E589. PMC. Web. 6 Feb. 2015.</ref>
			*

	==External Links==		==External Links==

Ostermayer at 15:23, 6 April 2015

2015-04-06T15:23:29Z

← Revisión anterior		Revisión del 15:23 6 abr 2015
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	\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=2107789		\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=2107789
	\| pdfurl=		\| pdfurl=
	\| status=~~Under Review~~		\| status=Complete
	}}		}}
	==Clinical Question==		==Clinical Question==

Ostermayer: /* Criticisms & Further Discussion */

2015-04-06T15:23:07Z

Criticisms & Further Discussion

← Revisión anterior		Revisión del 15:23 6 abr 2015
Línea 129:		Línea 129:

	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	This is best evidence to date the 1:1:1 ratio is a ~~worthy initial target~~. - ~~Ryan Radecki~~		*This was ultimately an unblinded and was a negative primary outcome due to the powering to detect only an absolute difference of 10% in mortality. To reach statistical significance for a small effect, 2968 patients would have been required to detect the observed difference of 4.2% (24 hour mortality) with 90% power. Regardless this is the best evidence to date the 1:1:1 ratio is a safe and effective treatment. <ref>Radecki R. The Fixed-Ratio Massive Transfusion Answer. http://www.emlitofnote.com/2015/02/the-fixed-ratio-massive-transfusion.html</ref>
			*Study design was randomized, multi-centre, and pragmatic, with minimal loss to 30 day followup, and allocation concealed during trial duration.
			*Transfusion complications may be more likely related to the increased use of platelets in the treatment arm.
			*This trial did not truly compare 1:1:1 vs 1:1:2 resuscitative strategies. Rather Holcomb et al examined a protocol intending to give 1:1:1 vs 1:1:2. In reality neither group truly reached their proportional expectations. The 1:1:1 group in actuality was given products closer to a 2:1:2 ratio, while the 1:1:2 group only received products in a 2:1:4 ratio. <ref> EM Nerd. The Adventure of the Blanched Soldier. http://emnerd.com/adventure-blanched-soldier/</ref>
			*Lab guided strategies in smaller sample sizes have not demonstrated 1:1:1 to be superior<ref> Bartolomeu et al. “Effect of a Fixed-Ratio (1:1:1) Transfusion Protocol Versus Laboratory-Results–guided Transfusion in Patients with Severe Trauma: a Randomized Feasibility Trial.” CMAJ : Canadian Medical Association Journal 185.12 (2013): E583–E589. PMC. Web. 6 Feb. 2015.</ref>

	==External Links==		==External Links==

Ostermayer at 13:58, 13 March 2015

2015-03-13T13:58:37Z

← Revisión anterior		Revisión del 13:58 13 mar 2015
Línea 13:		Línea 13:
	\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=2107789		\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=2107789
	\| pdfurl=		\| pdfurl=
	\| status="Under Review"		\| status=Under Review
	}}		}}
	==Clinical Question==		==Clinical Question==

Ostermayer at 13:58, 13 March 2015

2015-03-13T13:58:22Z

← Revisión anterior		Revisión del 13:58 13 mar 2015
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	\| issue= 5		\| issue= 5
	\| pages= 471-482		\| pages= 471-482
	\| pmid=		\| pmid= 25647203
	\| fulltexturl=		\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=2107789
	\| pdfurl=		\| pdfurl=
			\| status="Under Review"
	}}		}}
	==Clinical Question==		==Clinical Question==

Neil.m.young at 13:40, 13 March 2015

2015-03-13T13:40:02Z

← Revisión anterior		Revisión del 13:40 13 mar 2015
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	==Funding==		==Funding==
			*US National Heart, Lung, and Blood Institute grant U01HL077863
			*Department of Defense
			*The Defence Research and Development Canada in partnership with the Canadian Institutes of Health Research-Institute of Circulatory and Respiratory Health (grant CRR-120612)

	==Sources==		==Sources==