PREHOSPITAL BLOOD TRANSFUSION IN TRAUMA PATIENTS: A SYSTEMATIC REVIEW

Hemorrhage is the leading cause of preventable death in trauma. Damage control resuscitation (DCR) principles, including early blood product transfusion, are standard in-hospital, but their prehospital application remains an area of intense investigation. This systematic review synthesizes the current evidence on the efficacy, safety, and feasibility of prehospital blood transfusion (PHT) for trauma patients. A systematic literature search was conducted across PubMed, Scopus, Cochrane, and Web of Science for studies published between January 2015 and July 2024, following PRISMA guidelines. Sixteen studies, including cohort studies and systematic reviews, met the inclusion criteria and underwent qualitative synthesis. The evidence suggests that PHT is associated with a reduction in early mortality (e.g., 6-hour, 24-hour), particularly in patients with profound hemorrhagic shock, penetrating trauma, and prolonged prehospital times. PHT consistently improved hemodynamic parameters upon hospital arrival. The use of Low Titer O Whole Blood (LTOWB) demonstrated potential advantages over component therapy (e.g., packed red blood cells) in terms of survival and reduced overall blood product utilization. Transfusion-related adverse events were rare. Key logistical challenges included blood product storage, shelf-life, wastage, and cold chain management, with implementation being more established in helicopter EMS (HEMS) than ground services. Prehospital blood transfusion is a feasible and promising intervention that may improve early survival and physiological outcomes in severely injured trauma patients. While logistical hurdles exist, particularly for ground-based EMS, the evidence supports its role in bridging the gap to definitive care. Further high-quality, multi-center randomized controlled trials are needed to definitively establish efficacy, optimize transfusion strategies, and guide implementation across diverse EMS systems. Keywords: Prehospital Blood Transfusion, Trauma, Hemorrhagic Shock, Whole Blood, Damage Control Resuscitation.