RecentRCT

TOWAR

Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage.

The New England journal of medicine, 2026 · Pragmatic phase-III cluster randomized trial at 44 air bases

Population: 1,020 eligible trauma patients; 993 primary analysis
Intervention: Up to two prehospital whole-blood units
Comparator: As-indicated components
Primary outcome: 30-day all-cause mortality
Result: 25.9% versus 20.5%; adjusted OR 1.24 (95% CI 0.87–1.76), P=.24.

What the trial found

25.9% versus 20.5%; adjusted OR 1.24 (95% CI 0.87–1.76), P=.24.

Clinical interpretation

No significant benefit; base/time-block randomization and transport setting constrain extrapolation. Storage-age substudy observational, not a second randomized comparison.

Moderate certainty

Clinical Context & Relevant Topics (2)

Disease Reference

Major Bleeding, Hemorrhagic Shock, & Damage Control Resuscitation

The trauma lethal diamond (hypothermia, acidosis, coagulopathy, hypocalcemia), 1:1:1 massive transfusion (PROPPR trial), early TXA (CRASH-2), and TEG/ROTEM algorithms.

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Blood Product Transfusion in Critical Care

Patient-specific RBC transfusion thresholds, current platelet/procedural thresholds, plasma/cryoprecipitate use, and the TRALI vs TACO diagnostic matrix.

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