Comparative efficacy of prehospital resuscitation strategies on mortality for patients with major trauma: a network meta-analysis.
Chin-Wang Hsu, Wei-Kang Hung, Zizwani Brian Chilinda et al.
✦ AI-curated · Sources linked
In 30 seconds
This network meta-analysis of randomized controlled trials compared prehospital blood and non-blood resuscitation strategies in patients with major trauma. Across 15 trials involving 7504 participants, no strategy significantly reduced 24-hour or 28-day mortality compared with intravenous crystalloids alone. RBC plus plasma had the highest ranking probability for 24-hour mortality (65.8%), while tranexamic acid ranked highest for 28-day mortality (74.6%); these rankings did not establish significant superiority. The authors concluded that evidence is insufficient to identify a superior prehospital resuscitation intervention.
Key findings
- For 24-hour mortality, RBC plus plasma versus intravenous crystalloids alone had an OR of 0.68 (95% CI: 0.38-1.22), with no significant difference.
- For 28-day mortality, TXA versus intravenous crystalloids alone had an OR of 0.83 (95% CI: 0.35-1.92), with no significant difference.
- RBC plus plasma ranked highest for 24-hour mortality (65.8%); TXA ranked highest for 28-day mortality (74.6%).
Why it matters
Prehospital resuscitation choices are made in the context of major trauma and substantial risks of hemorrhage and organ failure. This synthesis finds no demonstrated mortality advantage for the evaluated blood or non-blood strategies over intravenous crystalloids alone. Ranking probabilities may help describe comparative uncertainty, but they should not be interpreted as proof that a strategy improves survival.
What to keep in mind
The analysis found no significant mortality differences, and the authors state that current evidence is insufficient to establish superiority; they call for future large-scale randomized trials.