Is There a Role for Prehospital Precision Resuscitation? A Prospective Multi-Institutional Blood Analysis

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Critical Care

Background:

• Civilian pre-hospital (PH) blood programs evolved from military experience.
• Whole blood (WB) is preferred for PH transfusion, but comparative data with packed red blood cells (pRBCs) is limited.
• Emergency Medical Services (EMS) systems increasingly adopt PH transfusion protocols.

Purpose of the Study:

• To compare patient outcomes between PH WB and pRBC transfusions.
• To evaluate the efficacy of WB versus pRBCs in diverse EMS systems.
• To test the hypothesis that WB leads to superior patient outcomes.

Main Methods:

• Prospective multicenter analysis of adult trauma patients receiving PH transfusion across 9 EMS systems (01/2020-12/2024).
• Exclusion criteria: isolated traumatic brain injury, penetrating head injury, PH cardiac arrest.
• Primary endpoint: in-hospital mortality.

Main Results:

• 339 patients included: 84 (24.9%) received WB, 255 (75.1%) received pRBCs.
• WB group had lower in-hospital transfusion requirements (2 pRBC units, 0 plasma units) vs. pRBC group (3 pRBC units, 2 plasma units).
• No significant difference in 24-hour or in-hospital mortality overall (WB vs. pRBCs: 7.1% vs. 13.7%, p=0.11).
• Subgroup analysis of blunt trauma patients showed a survival advantage for WB (94.1%) vs. pRBCs (79.5%, p=0.02).

Conclusions:

• Prehospital WB is not inferior to pRBCs overall.
• WB transfusion is associated with improved survival in blunt trauma patients.
• WB reduces subsequent in-hospital transfusion needs, supporting precision resuscitation strategies.