Efficacy and safety of prehospital whole blood resuscitation in traumatic haemorrhagic shock a systematic review and meta-analysis.

OBJECTIVE

To evaluate the efficacy and safety of prehospital whole blood (WB) resuscitation compared with the standard care blood components (BC) in adult patients with traumatic haemorrhagic shock.

METHODS

We included RCTs of adult patients with traumatic haemorrhagic shock requiring prehospital blood; non-randomised studies, non-traumatic haemorrhage, and combat casualties were excluded. PubMed/MEDLINE, CENTRAL, Embase, Scopus, the Web of Science, and ClinicalTrials.gov were searched from inception to 20 May 2026. Two reviewers assessed risk of bias using the Cochrane RoB 2 tool (cluster-randomised variant where appropriate). Dichotomous outcomes were pooled as odds ratios by generic inverse-variance under a random-effects model. The primary outcome of this review was all-cause mortality at 24 h after randomisation.

RESULTS

Three RCTs met the eligibility criteria, randomising 2048 patients (1695 in the trials' primary-analysis populations). Prehospital WB did not differ significantly from BC in 24-h all-cause mortality (OR 1.12, 95% CI 0.81-1.55; p = 0.49) or 28-30-day mortality (OR 1.15, 95% CI 0.90-1.47; p = 0.28). Massive transfusion within 24 h (OR 1.09, 95% CI 0.80-1.50) and thromboembolic complications (deep-vein thrombosis, pulmonary embolism, and ischaemic stroke) likewise showed no significant difference, with all confidence intervals crossing the null. Statistical heterogeneity was absent throughout (I2 = 0%).

CONCLUSION

Among adults with traumatic haemorrhagic shock, pooled randomised evidence showed no significant mortality benefit for prehospital whole blood over standard blood-component therapy. Because much of the observational evidence compared whole blood with crystalloid or no transfusion rather than with components, these randomised data refine rather than overturn that signal. Given only three trials of limited size and quality, the findings warrant caution, and adequately powered randomised trials are needed to confirm them and to identify the subgroups most likely to benefit.