AHRQ Seeks Feedback on Draft Report on EMS Blood and Fluid Resuscitation in Hemorrhagic Shock

The Agency for Healthcare Research and Quality (AHRQ) is seeking public comments on a draft evidence report that evaluates blood transfusion and fluid interventions for hemorrhagic shock in prehospital settings. The deadline to submit feedback is Sept. 18.

AHRQ developed a protocol with input from 14 experts to synthesize evidence about prehospital interventions for hemorrhagic shock, including whole blood, packed red blood cells (pRBCs), plasma, crystalloid fluids and bundled resuscitation strategies. The review included 121 studies published since 1990, most of which were rated moderate to high risk of bias.

The draft report found insufficient strength of evidence (SOE) to show that whole blood transfusion in the prehospital setting reduces mortality compared with no whole blood. It also found no difference in mortality for pRBCs compared to usual care, low SOE for plasma and insufficient or low SOE for crystalloid fluids. The report further found insufficient SOE for the effect of different transfusion strategies on mortality, although it identified a moderate to large mortality reduction when comparing the advanced resuscitative care bundle with usual care.

The draft report also identified several research gaps. AHRQ emphasized the need for more rigorous, generalizable studies that directly compare patient-centered outcomes across blood products and transfusion strategies. Future research should also address implementation factors, including trauma center and blood bank partnerships, organizational support, personnel training and systematic data collection, to strengthen the evidence base guiding prehospital transfusion programs.