Is There a Role for Prehospital Precision Resuscitation? A Prospective Multi-Institutional Blood Analysis

Authors

• Sydney Caputo, From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Caputo).
• Mark Piehl, Wake Forest University School of Medicine, Winston-Salem, NC (Piehl).
• Jacob Broome, Georgetown University Medical Center, Washington, DC (Broome).
• Gerrit Holleman, Tulane University, New Orleans, LA (Holleman, Taylor, Tatum).
• Caroline Taylor, Tulane University, New Orleans, LA (Holleman, Taylor, Tatum).
• Thomas Dransfield, New Orleans Medical Emergency Services, New Orleans, LA (Dransfield, Marino).
• Danielle Tatum, Tulane University, New Orleans, LA (Holleman, Taylor, Tatum).
• Alison Smith, LSU Health Sciences Center - New OrleansFollow
• Meg Marino, New Orleans Medical Emergency Services, New Orleans, LA (Dransfield, Marino).
• David Rayburn, LSU Health Sciences Center - New OrleansFollow
• Faris Azar, St. Mary's Medical Center, St. Ma, West Palm Beach, FL (Azar).
• Mario Gomez, Broward Healthcare System Inc, Fort Lauderdale, FL (Gomez, Rodriguez Mederos).
• Dalier Rodriguez Mederos, Broward Healthcare System Inc, Fort Lauderdale, FL (Gomez, Rodriguez Mederos).
• Kyle Gibson, Northeast Georgia Health System Inc, Gainesville, GA (Gibson, Krause).
• Morgan Krause, Northeast Georgia Health System Inc, Gainesville, GA (Gibson, Krause).
• David Hamilton, CommonSpirit Penrose Hospital, Colorado Springs, CO (Hamilton).
• Tomas Jacome, Franciscan Missionaries of Our Lady University, Baton Rouge, LA (Jacome, Davis).
• Greg Davis, Franciscan Missionaries of Our Lady University, Baton Rouge, LA (Jacome, Davis).
• Scott Branney, CommonSpirit Saint Anthony North Hospital, Westminster, CO (Branney, Harwood).
• Laura Harwood, CommonSpirit Saint Anthony North Hospital, Westminster, CO (Branney, Harwood).
• Warren Dorlac, Medical Center of the Rockies, Loveland, CO (Dorlac, Baxter).
• Bridget Baxter, Medical Center of the Rockies, Loveland, CO (Dorlac, Baxter).
• Ivan Puente, Delray Beach Medical Center, Delray, FL (Puente).
• Juan Duchesne, The University of Mississippi Medical Center School of Health Related Professions, Jackson, MS (Duchesne).

Document Type

Article

Publication Date

4-1-2026

Publication Title

Journal of the American College of Surgeons

Abstract

BACKGROUND: Military experience has paved the way for the development of civilian prehospital (PH) blood programs. Although whole blood (WB) is considered the product of choice for prehospital transfusion, data comparing WB to packed RBC (pRBCs) are lacking. We aimed to compare patient outcomes among multiple fast-paced emergency medical services systems nationwide, hypothesizing that overall patient outcomes with WB would be superior to pRBCs. STUDY DESIGN: This was a prospective multicenter analysis of adult trauma patients who received prehospital transfusion within 9 emergency medical services systems from January 2020 to December 2024. Patients with isolated traumatic brain injury, penetrating injury to the head, or PH cardiac arrest were excluded. The primary endpoint was in-hospital mortality. RESULTS: A total of 339 patients were included, 84 (24.9%) received WB and 255 (75.1%) pRBCs. Penetrating injury was more common in the pRBC group than in the WB group (54.1% vs 39.3%, p = 0.006). No differences were observed between groups in age, injury severity, or initial PH vital signs. In-hospital transfusion requirements at 24 hours were lower in the WB vs pRBC groups: pRBC units (2 vs 3, p <  0.001) and plasma units (0 vs 2, p <  0.001). Kaplan-Meier survival analysis revealed no difference in 24-hour mortality (3.5% vs 6.25%, p = 0.34) or mortality at hospital discharge (7.1% vs 13.7 %, p = 0.11) between WB and pRBCs groups, respectively (KM1). Subgroup analysis of only blunt injury (KM2) showed a survival advantage for WB vs pRBCs (94.1% vs 79.5%, p = 0.02). CONCLUSIONS: Although pRBCs were not inferior to WB overall, prehospital WB was associated with improved survival in blunt trauma patients and reduced subsequent in-hospital transfusion requirements, supporting injury-specific precision resuscitation strategies.

First Page

785

Last Page

793

PubMed ID

41568824

Volume

242

Issue

4

Publisher

Wolters Kluwer

Rights

Copyright © 2026 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

Recommended Citation

Caputo, Sydney; Piehl, Mark; Broome, Jacob; Holleman, Gerrit; Taylor, Caroline; Dransfield, Thomas; Tatum, Danielle; Smith, Alison; Marino, Meg; Rayburn, David; Azar, Faris; Gomez, Mario; Rodriguez Mederos, Dalier; Gibson, Kyle; Krause, Morgan; Hamilton, David; Jacome, Tomas; Davis, Greg; Branney, Scott; Harwood, Laura; Dorlac, Warren; Baxter, Bridget; Puente, Ivan; and Duchesne, Juan, "Is There a Role for Prehospital Precision Resuscitation? A Prospective Multi-Institutional Blood Analysis" (2026). School of Medicine Faculty Publications. 4640.
https://digitalscholar.lsuhsc.edu/som_facpubs/4640
10.1097/XCS.0000000000001780