{"title":"Prehospital whole blood for trauma: when two trials agree, the burden of proof shifts.","authors":"Amir L Butt, Kelsey C Waite, Kenichi A Tanaka","doi":"10.1016/j.bja.2026.09.010","DOIUrl":null,"url":null,"abstract":"<p><p>Two pragmatic randomised trials, published back-to-back in the same issue, tested whether prehospital low-titre group O whole blood improves survival after traumatic haemorrhage. TOWAR cluster-randomised 44 North American air medical bases, and SWiFT randomised individual patients across 10 English air ambulance services. Both returned the same null. At a dose of 2 units, whole blood was not superior to conventional components, and neither trial signalled meaningful harm. TOWAR's cluster allocation, which left the whole blood arm sicker at baseline and tied the product a patient received to the month of injury, can bias its point estimate but cannot explain why an independent, cleanly randomised trial reached the same endpoint. The operational case for whole blood, less wastage and functional platelets, is less well supported than it appears. Neither trial compared whole blood with goal-directed factor concentrate resuscitation, which may be the stronger strategy.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3000,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British journal of anaesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.bja.2026.09.010","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
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Abstract
Two pragmatic randomised trials, published back-to-back in the same issue, tested whether prehospital low-titre group O whole blood improves survival after traumatic haemorrhage. TOWAR cluster-randomised 44 North American air medical bases, and SWiFT randomised individual patients across 10 English air ambulance services. Both returned the same null. At a dose of 2 units, whole blood was not superior to conventional components, and neither trial signalled meaningful harm. TOWAR's cluster allocation, which left the whole blood arm sicker at baseline and tied the product a patient received to the month of injury, can bias its point estimate but cannot explain why an independent, cleanly randomised trial reached the same endpoint. The operational case for whole blood, less wastage and functional platelets, is less well supported than it appears. Neither trial compared whole blood with goal-directed factor concentrate resuscitation, which may be the stronger strategy.
期刊介绍：
The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience.
The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence.
Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.
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