In Brief: War Zones Vs. City Streets

Prehospital Blood-product Transfusions Fail to Boost Survival in Civilian Setting

In the military trauma setting, prehospital transfusion (PHT) is a firmly evidenced means to reduce preventable death. It stands to reason that the same would be true in the civilian emergency medical service (EMS) setting, but investigators from Beth Israel Deaconess Medical Center (BIDMC) found it would not be wise to jump to that conclusion. In a recent meta-analysis, investigators examined whether administering blood transfusions before hospital arrival improved trauma patients’ survival rates in civilian settings. The team conducted a meta-analysis on all three known randomized clinical trials evaluating 1-month survival in patients in the civilian setting randomized to PHT versus patients receiving no prehospital blood products.

While the scientists report finding a “suggestion of benefit—a 13 percent reduction in 1-month mortality,” these data failed to reach statistical significance. Overall, the analysis revealed a lack of evidence to support prehospital transfusion, which is costly and complex to execute, the authors note. Rather, the team suggests that while PHT in the civilian setting may improve survival for selected trauma cases, the evidence so far does not favor its widespread use—findings which should give pause to civilian emergency medical services systems moving forward with implementing prehospital transfusion programs based on an assumption of PHT’s lifesaving effects.

Read the full paper in Academic Emergency Medicine

BIDMC Study Authors: David W. Schoenfeld, Carlo L. Rosen, Stephen H. Thomas MD

COI: The authors declare no conflicts of interest.

Citation: Schoenfeld DW, Rosen CL, Harris T, Thomas SH. Assessing the one-month mortality impact of civilian-setting prehospital transfusion: A systematic review and meta-analysis. Acad Emerg Med. 2024;31:590-598. doi:10.1111/acem.14882