Prehospital whole blood transfusion in traumatic hemorrhagic shock: a systematic review and meta-analysis
In brief
Prehospital whole blood did not improve survival in 4,040 trauma patients
Across six studies, prehospital whole blood was not linked to lower 24-hour or 28-to-30-day mortality than standard care. Patients receiving it used about one fewer unit of red blood cells in the first 24 hours after hospital arrival, but that signal disappeared in sensitivity analysis and was driven mainly by observational studies at risk of bias. Its survival benefit remains unproven.
- Journal
- Injury (Q1)
- Published
- 23 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Marcelo Augusto Fontenelle Ribeiro Junior, Rafael Dib Possiedi, Leticia Stefani Pacheco, Nicolas de Cesaro Schpchacki, Lucas Fontenelle Vieira
- PMID
- 42815248
- DOI
- 10.1016/j.injury.2026.113732
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 2 October 2026): Prehospital whole blood meta‑analysis for hemorrhagic shock
- Picked for Emergency Medicine (paper of the day, 2 October 2026): Systematic review of prehospital whole blood transfusion in trauma
Abstract
BACKGROUND/OBJECTIVES: Prehospital whole blood (WB) is increasingly used for traumatic hemorrhagic shock due to logistical and physiological advantages. This study synthesized evidence, including recent RCTs, to clarify its clinical efficacy. METHODS: Six major databases were searched through May 22, 2026. Eligible studies included RCTs and comparative cohorts of adult patients receiving prehospital WB versus standard care. Primary outcomes were 24-hour and 28/30-day mortality. Data were pooled using random-effects models to calculate risk ratios (RR) and mean differences (MD) with 95% CIs. RESULTS: Synthesis of six studies (3 RCTs, 3 cohorts) involving 4040 patients (1558 WB; 2482 standard care) showed prehospital WB did not significantly decrease 24-hour mortality (RR 1.00; P = 0.98) or 28/30-day mortality (RR 1.09; P = 0.30). No differences were found in 6-hour or in-hospital mortality. However, WB significantly reduced red blood cell requirements within 24 h of hospital arrival (MD -0.97; P = 0.03), though this secondary signal lost statistical significance during sensitivity analysis. Safety outcomes (ARDS, stroke, thrombotic events) showed no significant differences, although estimates for rare events were imprecise. Certainty of evidence ranged from very low to moderate. CONCLUSION: Prehospital WB was not associated with improved short- or long-term survival compared with standard care. A reduction in 24-hour red blood cell transfusion requirements after hospital arrival was observed; however, this secondary finding was highly sensitive to individual study weight and was driven primarily by observational cohorts at serious risk of bias.
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.