In the past two decades, a growing number of hospitals have started using whole blood to treat trauma patients and those who need emergency transfusions based on prior evidence from both military and civilian studies. A new retrospective study of patients at Massachusetts General Hospital in Boston, however, questions the benefits of using whole blood for emergency transfusions. In April 2019, a policy change was established to administer low-titer group O whole blood for all emergency transfusions instead of packed RBCs. In this pre-post observational study, 602 adult patients (22.9% trauma) who received initial emergency transfusions of packed RBCs (2016-2019) were compared to 749 adult patients (23.2% trauma) who initially received whole blood (2019-2022). The median total volume of blood products transfused during the first 24 hours was 1276 mL for the packed RBC cohort compared to 1688 mL for the whole blood cohort (p=0.003); a similar increase in cost of blood products through day 7 for each patient was observed–$1110 vs $1686, respectively. No differences in survival at 24 hours or 30 days were observed between cohorts overall or in the subgroup who received massive transfusions. Prospective studies are needed to determine the best blood products that should be used for emergency transfusions.
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