Prehospital Whole Blood Administration in Adults With Hemorrhagic Shock and Its Association With Shock Physiology and Clinical Outcomes: A Systematic Review.

INTRODUCTION

Early resuscitation strategies, such as prehospital whole blood (PHWB) administration, are critical in improving patient outcomes in traumatic injuries with hemorrhagic shock. This systematic review aims to evaluate the effectiveness of PHWB transfusion in adult patients with hemorrhagic shock by evaluating its impact on outcomes and shock physiology.

METHODS

This systematic review used PubMed, ScienceDirect, and Cochrane to search for articles from January 1, 2016, to March 1, 2026. Studies meeting inclusion criteria were analyzed, focusing on the administration of prehospital whole blood in patients with hemorrhagic shock.

RESULTS

Thirteen studies met inclusion criteria after screening 1284 records. Across included studies, mortality findings were variable, with most studies reporting no significant differences in 24-h mortality (15.8% versus 11.2%) and 28-d mortality (25.0% versus 26.1%, P = 0.85). PHWB was consistently associated with greater reductions in shock index (0.43 versus 0.10, P < 0.001), higher rates of shock reversal (34.3% versus 16.6%; odds ratio [OR] 2.55), and improved predicted survival scores (54.4% versus 35.4%, P < 0.001), despite the absence of a consistent reduction in observed mortality across studies. Compared with component therapy, PHWB was associated with similar mortality but improved survival in high-risk patients (relative risk [RR] 0.52 for 4-h mortality; RR 0.70 for 28-d mortality). In penetrating trauma, PHWB was associated with improved survival (77% versus 56%, P < 0.01) and lower odds of death (OR 0.31, P < 0.05).

CONCLUSIONS

PHWB administration demonstrated consistent physiologic and resuscitative advantages compared with standard strategies, with potential survival benefit in select high-risk populations. Although a uniform mortality benefit was not observed, these findings support the role of PHWB in early hemorrhagic shock management, with further investigation needed to define its impact on long-term outcomes.