Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage
In brief
Prehospital whole blood does not lower trauma patients' 30-day mortality
In this multicenter trial, 30-day mortality was 25.9% with prehospital whole blood and 20.5% with blood components, with no significant difference between groups. Whole blood also showed no meaningful safety advantage, and mortality was similar whether it had been stored for up to 14 days or 15 to 21 days; the best prehospital transfusion strategy remains uncertain.
- Journal
- New England Journal of Medicine (Q1)
- Published
- 18 June 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Jason L Sperry, Francis X Guyette, Bryan A Cotton, James F Luther, Richard B Utarnachitt, Matthew E Kutcher, et al.
- PMID
- 42150044
- DOI
- 10.1056/NEJMoa2602167
Why clinicians should know about it
- Picked for Emergency Medicine (top studies of the week, 8 November 2026): Prehospital whole blood vs components in trauma
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.).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.