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Whole blood for prehospital transfusion did not reduce 30-day mortality compared to blood componentsTrial shows no survival benefit for whole blood over components

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Key Takeaway
Note that prehospital whole blood transfusion did not show a statistically significant mortality benefit over component therapy.

This phase 3 multicenter cluster-randomized trial evaluated the efficacy of prehospital transfusion for trauma patients experiencing hemorrhage and shock. The study enrolled 1020 eligible patients across air medical bases, with 695 assigned to receive up to 2 units of whole blood and 298 assigned to receive as-indicated blood components (plasma, red cells, or both).

The primary outcome was death from any cause within 30 days. The results showed a 30-day mortality rate of 25.9% in the whole-blood group compared to 20.5% in the component group. The adjusted odds ratio was 1.24 (95% CI [0.87 to 1.76]; P=0.24), indicating no statistically significant difference between the two treatment arms.

An observational substudy analyzed mortality based on storage age. For whole blood stored 15-21 days, mortality was 27.1% (adjusted odds ratio 0.99; 95% CI [0.74 to 1.32]). Mortality for blood stored 1-14 days was 26.4%, but the effect size and p-value were not reported. No substantial between-group differences in adverse events were observed.

A key limitation of this study is the observational nature of the substudy regarding storage age. While whole blood did not result in lower 30-day mortality than components, it should not be concluded as inferior based on these data. Clinical application remains nuanced for prehospital trauma management.

When a person suffers a severe injury and loses a lot of blood, every second counts. Doctors often have to decide quickly whether to use whole blood or specific components like plasma and red cells during emergency transport. This large study looked at exactly that choice for patients needing immediate transfusions.

The trial followed over 600 people who received whole blood and nearly 300 who received standard blood components. The results showed that while the mortality rate was slightly higher in the whole blood group, the difference was not statistically significant. This means the data did not prove that one method was better than the other for saving lives within 30 days.

Researchers also looked at how long the blood had been stored before use. They found no significant difference in survival regardless of whether the blood was fresh or older. While the study does not say whole blood is worse, it confirms that using it doesn't provide a measurable advantage over standard components for these patients.

What this means for you:
Whole blood did not show a better survival rate than standard blood components for trauma patients.

Study Details

Study typeRct
Sample sizen = 210
EvidenceLevel 2
Follow-up1.0 mo
PublishedJun 2026
View Original Abstract ↓
BACKGROUND: Blood transfusion before arrival at a hospital reduces mortality from traumatic hemorrhage and shock. Whether transfusion with whole blood is more beneficial than transfusion with blood components is uncertain, as are the effects of the length of time that blood products are in storage between donation and transfusion. METHODS: In this pragmatic, multicenter, phase 3, cluster-randomized trial, we assigned 44 air medical bases in a 2:1 ratio to the use of up to 2 units of whole blood or as-indicated blood components (plasma, red cells, or both) for prehospital transfusion in trauma patients during 1-month blocks. The primary outcome was death from any cause within 30 days after randomization. An observational substudy assessed outcomes according to the storage age of whole blood. RESULTS: Of 1020 eligible patients transported to hospitals by the air bases, 715 were assigned to receive whole blood and 305 to receive blood components; 695 and 298, respectively, were included in the primary analysis. Mortality at 30 days was 25.9% in the whole-blood group and 20.5% in the component group (adjusted odds ratio, 1.24; 95% confidence interval [CI], 0.87 to 1.76; P = 0.24). No substantial between-group differences in adverse events were observed. In the observational substudy, 30-day mortality was 27.1% among 210 patients who received whole blood with a storage age of 15 to 21 days and 26.4% among 443 patients who received whole blood with a storage age of 1 to 14 days (adjusted odds ratio, 0.99; 95% CI, 0.74 to 1.32). CONCLUSIONS: In injured patients with hemorrhagic shock, the use of whole blood for prehospital transfusion did not result in lower 30-day mortality than the use of blood components. (Funded by the Defense Health Agency Research Technology Portfolio Management, Combat Casualty Portfolio; TOWAR ClinicalTrials.gov number, NCT04684719.).
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