Prehospital whole blood transfusion versus component therapy-A scoping review

Whole blood has gained a foothold over component therapy in civilian emergency care, especially in emergency departments. In a prehospital setting, whole blood might be the logistically easier alternative compared to component therapy. However, most previous studies have been conducted in the emergency room setting. We performed a scoping review to explore what is known about the outcomes, safety and benefits of whole blood given prehospitally compared to component therapy in a primarily adult civilian population.

We formed a systematic search strategy and conducted a literature search in several databases. The study selection was done according to predefined inclusion and exclusion criteria. Our primary endpoint was survival at 24 h. Secondary endpoints were also analyzed.

The database search resulted in 1126 articles. After a systematic exclusion process, only six articles met the inclusion criteria. Whole blood usage was associated with similar mortality at 24 h and at other timepoints compared to component therapy. The analysis of secondary endpoints showed only minor or no differences between the groups.

The differences in the outcomes of interest between patients receiving prehospital whole blood versus component therapy were minor and, in most cases, not statistically significant. The analysis of the different endpoints showed whole blood not to be inferior to component therapy. There is a growing evidentiary support for the use of whole blood in prehospital emergency care, but to make treatment recommendations in the future, more published evidence is needed.