Traumatic hemorrhage remains a leading preventable cause of death in both civilian and military trauma cases. Damage Control Resuscitation (DCR) aims to provide early hemostatic support and to minimize crystalloid volume therapy. The prehospital use of plasma, red blood cell concentrates, fibrinogen, and whole blood is controversial on an international level. A structured narrative review of randomized controlled trials, multicenter registry analyses, and systematic reviews was conducted, focusing on mortality, transfusion needs, and safety. The evidence was compared across European, U.S., and military settings. European randomized trials show no significant mortality benefit for prehospital blood product administration, likely due to short transport times. In U.S. air medical systems with longer prehospital phases, there are indications of decreased 30-day mortality. Military registry data consistently indicate the benefits of early balanced transfusion strategies and whole blood in cases of prolonged evacuations. The advantage heavily depends on the time to definitive hemorrhage control. Prehospital blood product administration is safe and feasible, but its clinical benefit depends on the context. In military situations with extended evacuation times, early implementation of DCR is strategically important.
Jänig et al. (Thu,) studied this question.