This systematic review and meta-analysis evaluated prehospital whole blood (WB) vs. standard blood-component therapy (BC) in adult civilian trauma patients with haemorrhagic shock, pooling 3 RCTs (n=2,048 randomised; 1,695 in primary analyses) with outcomes including 24-h and 28–30-day all-cause mortality, massive transfusion, and thromboembolic complications.
Prehospital WB showed no significant mortality benefit over BC at 24 h (OR 1.12, 95% CI 0.81–1.55; p=0.49) or 28–30 days (OR 1.15, 95% CI 0.90–1.47; p=0.28); massive transfusion rates and thromboembolic events also did not differ significantly, with zero statistical heterogeneity across all outcomes (I²=0%).
- Only 3 RCTs of limited size and quality were available, leaving the analysis underpowered to detect clinically meaningful differences. - Combat casualties and non-traumatic haemorrhage were excluded, limiting generalisability to certain high-risk settings. - Prior observational evidence largely compared WB to crystalloid or no transfusion—not to BC—so residual confounding from that literature is not resolved here.
Current randomised evidence does not support switching prehospital resuscitation from standard blood components to whole blood for mortality benefit in civilian trauma. Clinicians should await adequately powered trials before making protocol changes based on this signal.
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