Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage.

Whether transfusion with whole blood is more beneficial than transfusion with blood components is uncertain, as are the effects of the length of time that blood products are in storage between donation and transfusion.

目前尚不确定，与成分输血相比，输注全血是否更有益，以及血液制品从捐献到输注的储存时间长短对效果的影响。

Methods

In this pragmatic, multicenter, phase 3, cluster-randomized trial, we assigned 44 air medical bases in a 2:1 ratio to the use of up to 2 units of whole blood or as-indicated blood components (plasma, red cells, or both) for prehospital transfusion in trauma patients during 1-month blocks.

在这项实用的、多中心的、第3阶段、群组随机试验中，我们按照2:1的比例，为44个空中医疗基地分配了使用最多2单位全血或根据需要的血液成分（血浆、红细胞或两者）进行院前创伤患者输血，在1个月的时间块内进行。

The primary outcome was death from any cause within 30 days after randomization.

主要结果是在随机分组后30天内因任何原因导致的死亡。

An observational substudy assessed outcomes according to the storage age of whole blood.

一项观察性子研究根据全血的储存时间评估了结果。

Results

Of 1020 eligible patients transported to hospitals by the air bases, 715 were assigned to receive whole blood and 305 to receive blood components; 695 and 298, respectively, were included in the primary analysis.

在由空军基地运送至医院的1020名符合条件的患者中，有715人被分配接受全血治疗，305人接受血液成分治疗；分别有695人和298人被纳入主要分析。

Mortality at 30 days was 25.9% in the whole-blood group and 20.5% in the component group (adjusted odds ratio, 1.24; 95% confidence interval[CI], 0.87 to 1.76; P = 0.24).

全血组30天死亡率为25.9%，成分血组为20.5%（调整后的比值比为1.24；95%置信区间[CI]，0.87至1.76；P = 0.24）。

No substantial between-group differences in adverse events were observed.

两组间不良事件的发生率没有显著差异。

In the observational substudy, 30-day mortality was 27.1% among 210 patients who received whole blood with a storage age of 15 to 21 days and 26.4% among 443 patients who received whole blood with a storage age of 1 to 14 days (adjusted odds ratio, 0.99; 95% CI, 0.74 to 1.32).

在观察性子研究中，210名接受储存期为15至21天的全血患者中，30天死亡率为27.1%，而443名接受储存期为1至14天的全血患者中，30天死亡率为26.4%（调整后的比值比为0.99；95% 置信区间为0.74至1.32）。

Conclusions

In injured patients with hemorrhagic shock, the use of whole blood for prehospital transfusion did not result in lower 30-day mortality than the use of blood components.

对于失血性休克的受伤患者，使用全血进行院前输血并未导致比使用血液成分更低的30天死亡率。

(Funded by the Defense Health Agency Research Technology Portfolio Management, Combat Casualty Portfolio; TOWAR ClinicalTrials.gov number, NCT04684719.).

(由国防卫生局研究技术投资组合管理、战斗伤亡投资组合资助；TOWAR ClinicalTrials.gov编号，NCT04684719。)