Whole Blood Transfusion in Air Medical Transport: The First Five Years

Prehospital blood transfusion is increasingly used in emergency medical transport, particularly for trauma-related hemorrhage. Whole blood (WB) has shown advantages over component therapy, i.e., packed red blood cells (PRBC), but data on its use for civilian indications remains limited.

This retrospective analysis reviewed air medical transport cases over a five-year period from 2019 to 2024 in which blood products were administered.

Data were compared between patients who received WB versus PRBCs, including patient demographics, transfusion indications, Rh status, and outcomes. Statistical analyses included chi-squared tests for categorical variables and Mann-Whitney U tests for continuous variables, with significance set at p<0.05.

The groups were demographically similar, and no transfusion-related complications were recorded. WB was significantly more likely to be used in trauma indications, while PRBC predominated in gastrointestinal (GI) bleeds and anemia. Of six Rh-negative women of child-bearing potential (under the age of 50) who received transfusions, two received WB, with one subsequently receiving Rh immunoglobulin. Mortality was higher in the WB group, most likely due to the severe nature of trauma cases.

The findings suggest that WB transfusion is an appropriate and effective option in air medical transport, particularly in trauma scenarios. The risk of alloimmunization appeared minimal, supporting the use of WB when Rh matching is not feasible. Further research is needed to assess the role of WB transfusion in non-trauma scenarios.