JAMA Netw Open. 2025 Jul 1;8(7):e2524368. doi: 10.1001/jamanetworkopen.2025.24368.
ABSTRACT
IMPORTANCE: Prehospital transfusion (PHT) of blood products by emergency medical services (EMS) has become common in civilian settings. However, variability exists in practices across the US. There are few large-scale data describing US civilian PHT with regard to blood products administered, potential exposure of females of childbearing potential to D-positive blood, or the proportion of PHT cases occurring in EMS transports of short duration.
OBJECTIVE: To evaluate nationwide PHT trends, regional differences, and potential risks, particularly for D-positive blood administration in females of childbearing potential.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study, Characteristics, Regional Evaluation, and D-Antigen in Transfusions by EMS (CREDIT-EMS), assessed data collected from January 1, 2020, to October 31, 2024 (before hypothesis generation), in trauma and nontrauma patients of all ages treated in 48 states in the US.
EXPOSURE: Prehospital-initiated transfusion of blood products.
MAIN OUTCOMES AND MEASURES: Age, sex, blood product characteristics (including blood type), and transport time. Comparative analyses were conducted using Pearson χ2, Wilcoxon rank sum, and nonparametric trend tests. Proportions were reported with binomial exact 95% CIs.
RESULTS: The study analyzed 10 444 patients (median [IQR] age, 45 [29-63] years; 7302 of 10 439 [70.0%] male) who received 18 177 units of blood products. The proportion of transfused units that were whole blood (WB) increased from 10.0% in 2020 to 30.8% in 2024 (P < .001). Regional variations in PHT were identified, with the Northeast having the highest proportion of WB use (33.2% of PHT). A total of 1589 (15.2%; 95% CI, 14.5%-15.9%) of the study patients were females of childbearing potential (aged 12-50 years), with an increasing number receiving D-positive blood products over time (73 of 169 [43.2%] in 2020 to 372 of 497 [74.9%] in 2024) (P < .001). Prehospital times were 20 minutes or less in only 255 of 10 343 cases (2.5%; 95% CI, 2.2%-2.8%).
CONCLUSIONS AND RELEVANCE: This cohort study of civilian PHT practices in the US found geographic and temporal variability. There was increasing adoption of WB and significant implications for females of childbearing potential who are increasingly likely to receive D-positive PHT. Cases of PHT uncommonly involved short prehospital duration. These findings highlight the need for standardized protocols and further evaluation of risk-benefit considerations.
PMID:40742584 | DOI:10.1001/jamanetworkopen.2025.24368
