Laura Green

Whole-blood transfusion has recently gained favor in the management of severe hemorrhage; however, data from large clinical trials evaluating its clinical effectiveness and safety are lacking. We conducted a pragmatic, phase 3, multicenter, unblinded, randomized, superiority trial across 10 air ambulance services in England. Patients with major traumatic hemorrhage who were attended by a participating air ambulance service were randomly assigned to receive either whole-blood transfusion (up to 2 units) or standard care with blood components (up to 2 units each of red cells and plasma) before arrival at the hospital. The primary outcome was a composite of death from any cause or massive transfusion (≥10 units of blood components or products) within 24 hours after randomization. A total of 942 patients underwent randomization. After the exclusion of participants with nontraumatic hemorrhage or traumatic cardiac arrest, 616 were included in the analysis (314 in the whole-blood group and 302 in the standard-care group). A primary-outcome event occurred in 48.7% of the participants in the whole-blood group and in 47.7% of those in the standard-care group (relative risk, 1.02; 95% confidence interval, 0.80 to 1.31; P = 0.84). The incidence of death from any cause at all time points, massive transfusion, and other secondary outcomes appeared to be similar in the two groups. Prothrombin times were above the normal range in 40.7% of the participants in the whole-blood group and in 30.5% of those in the standard-care group. More serious adverse events occurred in the standard-care group than in the whole-blood group (37 and 31, respectively). The incidence of thrombotic events appeared to be similar in the two groups. Among participants with life-threatening hemorrhage, prehospital transfusion of 2 units of whole blood was not superior to standard care in reducing the risk of death or massive transfusion within 24 hours. (Funded by NHS Blood and Transplant and others; ISRCTN Registry number, ISRCTN23657907.).

Background and Objectives: Bedside electronic transfusion checks (BETC) enhance transfusion safety by reducing errors associated with manual processes. Despite national recommendations, BETC adoption in the United Kingdom remains limited. This study reports on the implementation of BETC at four hospitals at Barts Health NHS Trust, aiming to share insights on the implementation process. Materials and Methods: The main implementation was split into three phases: (1) pre‐pilot, (2) pilot and (3) main implementation (2022–2025). Staff surveys on training satisfaction and key performance indicators (KPIs) on transfusion activity were used to evaluate the uptake of the BETC system. Statistical process control (SPC) charts were used to identify trends, variation and patterns in the data following the implementation of BETC. Results: A total of 5079 staff were trained and 404 personal digital assistant (PDA) devices deployed across four hospitals. Early implementation highlighted that training 60% of staff was insufficient for optimal system use, increasing this threshold to 80% improved adoption. BETC was initially more commonly used for blood administration than group and screen (G&S) sample labelling. Over time, increased usage of BETC for G&S labelling correlated with a marked reduction in sample rejection rates across all sites. Staff reported high satisfaction with training, with 99.5% rating it positively. Conclusion: Early adopters played a pivotal role, but achieving widespread adoption required extended training and support. Addressing technical and workflow barriers, coupled with mandatory system use, could enhance the speed of impact of BETC. These insights offer guidance for future adopters aiming to improve transfusion safety and efficiency.

Fresh frozen plasma (FFP) is the standard treatment for severe bleeding following cardiac surgery. Despite increasing use of prothrombin complex concentrat

Introduction: Delivering balanced blood resuscitation at the point of injury remains a significant logistical challenge in prehospital trauma care. To inform optimal transfusion strategies in austere environments, we conducted a simulation-based study comparing the operational demands of three prehospital transfusion approaches. Methods: Three doctor–paramedic teams (six clinicians) undertook a crossover simulation of traumatic haemorrhage, completing all three arms in random order: two units red-cells-in-plasma (RCP), two units red blood cells plus two units thawed fresh frozen plasma (RBC+FFP), and two units red cells plus two units lyophilised plasma (RBC+LyoP). Outcomes were flow time (defined as time from decision-to-transfuse to completion of transfusion of all units), touch time (hands-on time) and process burden (steps, equipment, checks, personnel), timed in real-time and verified on video. A postscenario questionnaire captured user perceptions. Results: All scenarios were completed without missing data. RCP consistently required the least time and operational effort. Median flow times (min:s) were 06:31 (RCP), 12:20 (RBC+FFP) and 16:29 (RBC+LyoP) (p=0.019). Median touch times (min:s) were 02:31 (RCP), 05:21 (RBC+FFP) and 13:03 (RBC+LyoP) (p=0.017). Touch/flow ratios were lowest for RCP (0.39), indicating reduced cognitive and physical load. Standardised process mapping identified 26 steps for RCP versus 46 for RBC+FFP and 52 for RBC+LyoP, reflecting a single set-up and one repetition for RCP compared with multiple repetitions and added reconstitution steps for LyoP. Equipment (4, 10, 12), checks (8, 16, 16) and personnel required (2, 2, 3) followed the same efficiency gradient. Five of six participants rated RCP as optimal for the patient, and all six for the crew; LyoP was unanimously judged as the most demanding. Conclusions: In a simulated trauma scenario, a combined RCP component was delivered more quickly and with substantially less process burden than separate components. These operational gains support combined-component strategies for prehospital haemorrhage resuscitation in both military and civilian settings.

Introduction: Major haemorrhage is the leading cause of preventable death in trauma, and prehospital blood transfusion may improve survival and outcomes for patients with prolonged out-of-hospital times. Globally, there is increasing interest in the use of whole blood in the prehospital environment, with randomised controlled trials ongoing. However, the results of these studies may not be generalisable to the longer out-of-hospital times seen in the Canadian trauma environment. The aim of this trial is to determine the feasibility of performing a randomised clinical trial evaluating the use of leukocyte-reduced whole blood transfusion compared with component blood transfusion in the Canadian prehospital environment. The secondary objective is to explore whether whole blood transfusion is better in reducing the proportion of patients who die or require massive transfusion within 24 hours. Methods and analysis: This is a multi-centre, open-label, randomised controlled feasibility trial. Patients aged 16 years or older will be eligible if they have suffered a major traumatic haemorrhage, are attended by the provincial air ambulance service and require a prehospital blood transfusion. The primary outcome is feasibility as measured by the following metrics: proportion of patients enrolled with full data collection, proportion of patients who received at least one prehospital transfusion prior to arriving at the receiving trauma centre, proportion of patients who completed transfusion of all assigned blood units, number of patients unable to be enrolled due to lack of whole blood availability and number of whole blood units produced for the study that were wasted or expired. The secondary outcome is a composite outcome of death (all-cause mortality) or receipt of massive transfusion (receipt of 10 units of blood or more) within the first 24 hours from randomisation. We plan to recruit 60 patients, with an anticipated post-randomisation exclusion of ~10 patients for traumatic cardiac arrest or who do not meet eligibility criteria. Ethics and dissemination: Provincial ethics approval was obtained (Clinical Trials Ontario REB ID: CTO-4921). An opt-out consent model will be employed for participants. The SWiFT Canada trial will recruit 60 patients through the provincial air ambulance organisation in Ontario who are transported to one of the six participating lead trauma centres. It will investigate the feasibility of a pre-hospital transfusion clinical trial in Canada to compare the effectiveness of whole blood compared with component blood therapy in a future definitive trial. Trial registration number: ClinicalTrials.gov: NCT06495294 ( https://clinicaltrials.gov/study/NCT06495294 ), Clinical Trials Ontario: CTO-4921.

Background: Every time a unit of blood is given to a patient, it is essential that all steps in the transfusion pathway are executed correctly to ensure that the right blood is transfused to the right patient. Bedside transfusion checks at the point of sampling for compatibility testing, sample labelling and blood administration are an essential part of the delivery of safe transfusion and avoidance of the wrong blood being given, which can have serious consequences. Implementation of bedside electronic transfusion systems that use barcode matching of patients' wristbands and blood units is now recommended as the best practice to ensure patients' safety in transfusion. However, there is limited information in the literature to guide hospitals on what aspects they should consider when introducing a bedside electronic transfusion system. Aims and Methods: This paper aims to support hospitals considering implementing a bedside electronic transfusion system by providing a comprehensive checklist addressing planning, stakeholder coordination, device integration, and compliance with national standards and safety requirements. Results: The checklist is based on the experiences of two NHS Trusts in the UK and aims to provide organisations with a resource to support this change and reduce avoidable delays.

Background: We tested the hypothesis that the addition of biomarkers of multimorbidity and biological aging would improve the predictive accuracy of point‐of‐care viscoelastometry or laboratory tests of coagulation for clinically important bleeding following cardiac surgery. Study design and methods: This predictive accuracy study included 2437 participants in the coagulation and platelet laboratory testing in cardiac surgery (COPTIC study) with complete clinical, TEG 5000 thromboelastography, ROTEM, multiplate aggregometry, full blood count, laboratory reference tests of coagulopathy, and biomarkers of biological aging and multimorbidity. Models with different biomarkers to predict the composite primary outcome, clinically important bleeding, were developed using logistic regression and internally validated using 10‐fold cross‐validation. Discrimination, calibration, and clinical utility of the models were assessed comprehensively. Results: For the composite primary outcome, the AUROC for the best predictive model using TEG or ROTEM plus other biomarkers was 0.694 (0.612–0.775). The best predictive model overall included laboratory reference tests of coagulation, full blood count results, and biomarkers of multimorbidity and aging, AUROC = 0.701 (0.620–0.781), although clinical utility was not superior to using laboratory reference tests alone. Discrimination was higher for individual components of the primary outcome: large volume (≥4 units) red cell transfusion 0.754 (0.602–0.903) and large volume procoagulant transfusion 0.723 (0.590–0.857), but not for excess loss in drains/re‐sternotomy 0.701 (0.613–0.788). Calibration was generally good among the models. Discussion: The addition of biomarkers of multimorbidity and biological aging yielded only small improvements in model predictive accuracy for bleeding over tests of coagulation. Existing clinical definitions of bleeding likely represent heterogeneous phenotypes and disease mechanisms.

Background: Anaemia significantly affects health outcomes and quality of life. While blood transfusion remains a common intervention, alternative treatments, such as iron supplementation and erythropoiesis‐stimulating agents (ESAs), offer potential to mitigate transfusion‐associated costs. However, robust evidence on their cost‐effectiveness remains limited.Objective: This review assesses the cost‐effectiveness of anaemia treatments, aiming to inform UK healthcare policy and practice.Methods: A systematic review was conducted following PRISMA guidelines, identifying economic evaluations published between 2015 and 2025. Study quality was appraised using the Drummond checklist and NICE reference case criteria. Data were synthesised using the Hierarchical Decision Matrix framework.Results: Of 5496 records screened, 14 studies met inclusion criteria; 11 were included in the final synthesis, with three excluded due to low methodological quality. Restrictive transfusion strategies were cost‐saving (£35.50–£75 per patient), reduced red blood cell utilisation by ∼21%, shortened length of stay by 0.5 to 3 days, and yielded modest QALY gains (0.01 to 0.02). ESAs reduced transfusion risk (RR 0.61 to 0.87) but incurred substantial incremental costs (£1859–£3060) with limited evidence of QALY gains. Transfusion of fresher blood in ICU settings increased costs without a measurable clinical or economic advantage. Preoperative erythropoietin and ferric carboxymaltose reduced transfusion incidence but were high‐cost interventions with limited evidence on QALY gains. Patient Blood Management (PBM), particularly intravenous iron, was cost‐saving (£30.80–1166 saved per patient), reduced transfusion rates (RR 0.61), but with limited evidence on QALY gains.Conclusion: Restrictive transfusion thresholds and PBM interventions, especially intravenous iron, demonstrate favourable cost‐effectiveness and potential for NHS cost savings. In contrast, the cost‐effectiveness of ESAs remains uncertain due to high costs and limited utility evidence. Further research is needed to capture long‐term outcomes and generate UK‐specific economic data.Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.

Summary: Electronic blood transfusion (EBT) systems have the potential to significantly enhance patient safety and healthcare efficiency. Although national guidelines recommend their implementation, widespread adoption requires addressing gaps in evidence regarding cost‐effectiveness and clinical impact. This study assessed EBT implementation in English hospitals via a 2023 survey focusing on three key components: (i) electronic blood fridges (EBFs) for traceability and stock management, (ii) electronic blood ordering systems with clinical decision support (CDSS) and (iii) bedside patient identification (PID) systems. The survey also examined EBT integration with electronic health records (EHRs) and inter‐hospital record linkages. Among 206 surveyed hospitals, 114 responded, resulting in a 55.6% response rate. Of the responding sites, 76 (67.3%) had implemented at least one EBT component. EBFs were the most adopted technology (65 sites; 57.5%), followed by bedside identification systems (37 sites; 32.7%). Advanced systems like CDSS were implemented in only 16 sites (14.2%). Barriers to adoption included financial constraints, limited senior management engagement and technical challenges. Our results show variability in EBT system adoption across NHS England hospitals. There is a pressing need for cost‐effectiveness analyses to support investment decisions, while evidence of clinical effectiveness is needed to justify advanced EBT systems and overcome organisational barriers.