Carlos A. Metidieri Menegozzo: The First Priority in Trauma Transfusion May Be Time to First Blood Product
Carlos A. Metidieri Menegozzo, Clinical Fellow, Surgical Nutrition and Intestinal Failure at Jackson Memorial Hospital, shared a post on LinkedIn:
“Whole blood has been trauma’s favorite comeback story for a decade. This year, two randomized trials in the New England Journal of Medicine tested it prehospital, head to head against standard components.
In England‘s SWiFT trial, up to two units of whole blood versus red cells and plasma gave the same result: death or massive transfusion within 24 hours occurred in 48.7% vs 47.7% (relative risk 1.02, 95% CI 0.80-1.31). The US TOWAR trial found no significant 30-day mortality difference either (25.9% vs 20.5%, whole blood vs components).
I don’t read that as a defeat for whole blood.
I read it as a reframe: the form of blood may matter less than whether balanced transfusion is available at all, at the moment it’s needed.
A Brazilian survey of trauma professionals found massive transfusion protocols available to under half of respondents, and whole blood in fewer than one in five.
If that’s right, the first audit isn’t ‘do we stock whole blood?’ It’s ‘how long until a patient bleeding overnight gets a first unit of anything?’
Does your service track time to first blood product, or only whether the protocol exists?”
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