Prehospital whole blood transfusion in traumatic hemorrhagic shock: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared prehospital whole blood (WB) with standard care in adults with traumatic hemorrhagic shock, pooling three randomised trials and three comparative cohort studies. Across 4040 patients, WB was not associated with lower 24-hour mortality (RR 1.00; P = 0.98) or 28/30-day mortality (RR 1.09; P = 0.30); no differences were found in 6-hour or in-hospital mortality. WB was associated with fewer red blood cell transfusions within 24 hours of hospital arrival, but this secondary result was not robust in sensitivity analysis. Evidence certainty ranged from very low to moderate.

Key findings

• Across 4040 patients, 24-hour mortality did not differ significantly with WB versus standard care (RR 1.00; P = 0.98).
• There was no significant difference in 28/30-day mortality (RR 1.09; P = 0.30), 6-hour mortality, or in-hospital mortality.
• WB was associated with reduced red blood cell requirements within 24 h of hospital arrival (MD -0.97; P = 0.03), but this signal lost significance in sensitivity analysis.
• No significant differences were found in ARDS, stroke, or thrombotic events; estimates for rare events were imprecise.

Why it matters

Prehospital WB is intended to support resuscitation before hospital arrival, but this synthesis found no evidence of improved short- or longer-term survival compared with standard care. The possible reduction in subsequent red blood cell use may be relevant to transfusion planning, yet its sensitivity to study weighting and reliance on observational cohorts make that finding uncertain.

What to keep in mind

Evidence certainty ranged from very low to moderate. The red blood cell transfusion finding was sensitive to individual study weight and driven primarily by observational cohorts at serious risk of bias; estimates for rare safety events were imprecise.