Fresh whole blood: A feasible alternative in disasters and mass casualty incidents? a systematic review and meta-analysis

Introduction: While balanced blood component therapy (BCT) is pivotal in trauma patient damage control resuscitation in well-resourced settings, disasters, and mass casualty incidents (MCIs) pose significant challenges, especially in securing sufficient access to blood products. This systematic review and meta-analysis aim to explore the utilization of fresh whole blood (FWB) transfusion as a potential alternative to BCT, informing future research and clinical strategies. Methods: We searched Pubmed, MEDLINE, Embase, CINAHL, the Cochrane Library and grey literature for articles identifying FWB transfusions, limited to those published in English or French. We evaluated the outcomes of post-FWB transfusion and conducted a meta-analysis comparing overall mortality in patients receiving FWB in addition to BCT during damage control resuscitation with those receiving BCT or single blood components alone. Results: Of the 4830 studies identified, only 74 articles met all the eligibility criteria; the majority of them were conducted in military contexts. Mortality was lower among the FWB group compared to the BCT alone group, with a pooled OR of 0.61 (95% CI: 0.38-0.98) overall, and a pooled OR of 0.47 (95% CI: 0.25-0.87) among studies adjusting for confounders. FWB transfusion related complications rarely occurred. Conclusions: While FWB shows potential as an alternative to BCT for managing severe haemorrhagic shock in disasters and MCIs, additional research is essential to validate FWB's efficacy before considering it as a standard approach in civilian scenarios. Further studies focusing on the feasibility of implementing FWB in civilian contexts are also warranted.