Study of Whole blood in Frontline Trauma (SWiFT): implementation study protocol

Area of Science:

• Trauma care and emergency medicine
• Blood transfusion and hematology
• Health services research and implementation science

Background:

• Uncontrolled bleeding is a leading cause of death in major trauma.
• Current transfusion practices are variable, with uncertainty regarding optimal strategies.
• Prehospital whole blood (WB) transfusion is a potential alternative to component therapy for major bleeding.

Purpose of the Study:

• To assess the efficacy, cost-effectiveness, and implementation of prehospital WB transfusion.
• To evaluate the acceptability and integration of WB transfusion into clinical settings.
• To identify contextual factors influencing the success or failure of prehospital WB transfusion.

Main Methods:

• A multicentre randomised controlled trial with a type 1 effectiveness-implementation hybrid design.
• Qualitative methods including interviews and focus groups with operational staff, patients, and donor representatives.
• Data analysis guided by Normalisation Process Theory and Theoretical Framework of Acceptability.

Main Results:

• Effectiveness, cost-effectiveness, and implementation data are currently being collected.
• Qualitative data will explore staff and stakeholder perspectives on WB transfusion.
• Study aims to provide evidence for optimal prehospital transfusion strategies.

Conclusions:

• Evidence on the effectiveness and safety of prehospital WB transfusion compared to component therapy is limited.
• This study will provide crucial data on the feasibility and impact of implementing WB transfusion in emergency settings.
• Findings will inform future clinical guidelines and practice for managing major trauma bleeding.