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Review
. 2024 Dec 19;18(1):74.
doi: 10.1186/s13031-024-00635-z.

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

Alba Ripoll-Gallardo #  1 , Marta Caviglia #  2   3 , Matteo Ratti  4 , Daniele Ceriotti  4 , Grazia Meneghetti  5 , Luca Pigozzi  6 , Maria Brönstad  7 , Luca Ragazzoni  5   8 , Francesco Barone-Adesi  5   4
Affiliations
Review

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

Alba Ripoll-Gallardo et al. Confl Health. .

Abstract

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.

Keywords: Damage control resuscitation\; Disasters; Fresh whole blood; Mass casualty incidents; Walking blood banks.

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Conflict of interest statement

Declartions. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
Fig. 2
Fig. 2
Overall mortality after FWB administration
Fig. 3
Fig. 3
Analysis restricted to studies that provided estimates adjusted for possible confounders
See this image and copyright information in PMC

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