¿Existe un papel para la reanimación de precisión prehospitalaria? Un análisis prospectivo multiinstitucional de...

Military experience has paved the way for the development of civilian pre-hospital (PH) blood programs. While whole blood (WB) is considered the product of choice for prehospital transfusion, data comparing WB to packed red blood cells (pRBCs) are lacking. We aimed to compare patient outcomes among multiple fast-paced emergency medical services (EMS) systems nationwide, hypothesizing that overall patient outcomes with WB would be superior to pRBCs.

This was a prospective multicenter analysis of adult trauma patients who received prehospital transfusion within 9 EMS systems from 01/2020 to 12/2024. Patients with isolated traumatic brain injury, penetrating injury to the head, and/or PH cardiac arrest were excluded. The primary endpoint was in-hospital mortality.

A total of 339 patients were included, 84 (24.9%) received WB and 255 (75.1%) pRBCs. Penetrating injury was more common in the pRBC group than the WB group (54.1% vs 39.3%, p=.006). No differences were observed between groups in age, injury severity, or initial pre-hospital vital signs. In-hospital transfusion requirements at 24-hours were lower for the WB vs pRBC groups: pRBC units (2 vs. 3, p <0.001) and plasma units (0 vs. 2, <0.001). Kaplan Meier survival analysis revealed no difference in 24-hour mortality (3.5% vs 6.25%, p = 0.34) or mortality at hospital discharge (7.1% vs 13.7 %, p=0.11) for WB and pRBCs groups, respectively (KM1). Subgroup analysis of only blunt injury (KM2) showed a survival advantage for WB vs. pRBCs (94.1% vs. 79.5%, p=0.02).

While pRBCs were not inferior to WB overall, prehospital WB was associated with improved survival in blunt trauma patients and reduced subsequent in-hospital transfusion requirements, supporting injury-specific precision resuscitation strategies.