Prehospital Blood Product Transfusion and Combat Injury Survival

To the Editor Dr Shackelford and colleagues¹ reported that prehospital blood product transfusion was associated with improved survival at 24 hours and 30 days during medical evacuation of combat casualties compared with delayed transfusion. Although the study was well constructed, we have several concerns.

First, the improvement in survival with prehospital transfusion appeared to occur almost exclusively during the very first hours or even as early as the prehospital phase; however, the number of patients who arrived alive at the hospital was not specified. Thus, the difference may be related to the quality of prehospital resuscitation rather than prehospital transfusion, which on average included only 1 U of red blood cells or plasma.