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TOPLINE:

A phase 3 trial of patients with trauma suggested that prehospital transfusion with low-titer group O whole blood was not associated with reduced 30-day mortality compared with prehospital transfusion with blood components in patients at a risk for hemorrhagic shock.

METHODOLOGY:

• Researchers conducted a pragmatic, multicenter, phase 3 cluster-randomized trial involving 1020 patients with trauma who required prehospital transfusion across 44 air medical bases and 11 US trauma centers between 2022 and 2025.
• A total of 715 patients were assigned to receive whole blood, and 305 were assigned to receive blood components.
• The primary outcome was death from any cause within 30 days, and secondary outcomes included early mortality (at 3, 6, and 24 hours), blood product transfusion volumes, and adverse events.

TAKEAWAY:

• Prehospital transfusion with whole blood was not associated with reduced 30-day mortality compared with prehospital transfusion with blood components (25.9% vs 20.5%; adjusted odds ratio [OR], 1.24; 95% CI, 0.87-1.76).
• No significant differences were observed between the groups regarding early mortality, in-hospital mortality, transfusion requirements, and occurrences of multiple organ failure, nosocomial infection, and acute respiratory distress syndrome.
• Among patients who received whole blood, 30-day mortality was similar between those who received blood stored for 15-21 days and those who received blood stored for 1-14 days (27.1% vs 26.4%; adjusted OR, 0.99; 95% CI, 0.74-1.32).
• The rates of adverse events and serious adverse events were comparable between the whole blood and blood component groups and across whole blood storage durations.

IN PRACTICE:

"In patients at risk for hemorrhagic shock who underwent blood transfusion, the use of whole blood did not result in lower 30-day mortality than the use of blood components," the authors wrote.

"The storage age of whole blood through 21 days from donation was not associated with apparent differences in outcomes," they added.

SOURCE:

The study was led by Jason L. Sperry, MD, University of Pittsburgh, Pittsburgh. It was published online on May 18, 2026, in The New England Journal of Medicine.

LIMITATIONS:

The cluster-randomized design may have introduced limitations. Blood product crossover between treatment groups and transfusions administered before randomization may have reduced differences between the groups. The intervention was not masked, introducing potential treatment bias, and coagulation and platelet function analyses were limited by missing data. In addition, unmeasured confounders and the relatively low volume of prehospital vs in-hospital transfusions may have affected the findings.

DISCLOSURES:

The study was funded by the Congressionally Directed Medical Research Programs and the US Army Medical Research Acquisition Activity. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.