While balanced blood component therapy (BCT) is pivotal in trauma patient damage control resuscitation in well-resourced settings, disasters and mass casualty incidents (MCIs) pose significant challenges, especially in securing sufficient access to blood products. In this context, fresh whole blood (FWB) could be a feasible and rapidly available alternative to BCT for life-threatening hemorrhages.

This systematic review and meta-analysis aim to explore the utilization of fresh whole blood (FWB) transfusion as a potential alternative to BCT, informing future research and clinical strategies.

We searched PubMed, MEDLINE, Embase, CINAHL, the Cochrane Library and grey literature for articles identifying FWB transfusions. We evaluated the outcomes of post-FWB transfusion and conducted a meta-analysis comparing overall mortality in patients receiving FWB in addition to BCT during damage control resuscitation with those receiving BCT or single blood components alone.

Of the 4830 studies identified, only 74 articles met all the eligibility criteria; the majority of them were conducted in military contexts. Mortality outcomes did not differ between FWB vs BCT alone group, with a pooled OR of 0.61 (95% CI: 0.38 – 0.98) overall, and a pooled OR of 0.47 (95% CI: 0.25 – 0.87) after adjusting for confounders. FWB transfusion related complications rarely occurred.

While FWB shows potential as an alternative to BCT for managing severe hemorrhagic shock in disasters and MCIs, additional research is essential to validate FWB’s efficacy before considering it as a standard approach in civilian scenarios. Further studies focusing on the feasibility of implementing FWB in civilian contexts are also warranted.