Systematic ReviewResearchWorkflowMedication Safety

Prehospital whole blood improved shock measures without a consistent mortality benefit

The Journal of surgical research (PubMed)Aug 13, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A systematic review found that prehospital whole-blood transfusion in adults with hemorrhagic shock consistently improved shock physiology, while studies did not show a uniform mortality benefit across populations.

What NurseJet pulled from the source

Thirteen studies were included. Whole blood was associated with greater shock-index improvement and more shock reversal; overall 24-hour and 28-day mortality findings were variable, although selected high-risk and penetrating-trauma subgroups showed survival signals.

Why this matters for nurses

Emergency and trauma nurses receive patients during the handoff from prehospital resuscitation and must rapidly account for products already given, ongoing hemorrhage, response, and complications. The review supports close physiologic tracking without assuming that early improvement guarantees survival.

Bedside takeaway

At trauma handoff, reconcile prehospital whole blood and keep trending hemorrhage and perfusion despite early physiologic improvement.

How This Applies in Practice

Use this when: Receiving an adult with hemorrhagic shock who received, or may be eligible for, whole blood under an authorized trauma pathway.

On your shift

Confirm product type, unit identifiers, volume, timing, warming, vascular access, observed response, and any suspected reaction during handoff.
Continue protocol-based hemorrhage control and trend mental status, perfusion, shock measures, temperature, bleeding, and response to each resuscitation step.
Coordinate ordered sampling, blood-bank communication, massive-transfusion tracking, calcium and temperature management, and rapid escalation of deterioration.

Keep in mind: The review did not show a uniform mortality benefit or define universal eligibility. Follow the trauma protocol, facility transfusion policy, and provider orders.

Key takeaways

The review synthesized 13 studies of prehospital whole-blood use in adult hemorrhagic shock.
Physiologic measures, including shock index and shock reversal, generally favored whole blood over standard strategies.
A consistent mortality reduction was not demonstrated across the included studies.
Subgroup survival signals are hypothesis-generating and do not establish which patients should receive whole blood.

Practice implications

During trauma handoff, capture the product, volume, timing, warming method, response, and suspected transfusion reactions. Continue the hemorrhage pathway, trend perfusion and bleeding, obtain ordered samples without delaying resuscitation, and coordinate blood-bank and massive-transfusion communication.

Limitations & cautions

The 13 studies were heterogeneous and mortality findings varied. The abstract does not report a pooled overall mortality estimate or establish causal benefit, and favorable subgroup findings may be affected by selection, protocol, and survivorship differences.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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The Journal of surgical research (PubMed)

The Journal of surgical research (PubMed). Prehospital Whole Blood Administration in Adults With Hemorrhagic Shock and Its Association With Shock Physiology and Clinical Outcomes: A Systematic Review.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42594587/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Pediatric emergency care (PubMed)Sep 7, 2026Research Article

A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

Peds EmergencyAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Journal of neurosurgical anesthesiology (PubMed)Sep 4, 2026Research Article

A five-center randomized trial found similar rescue-opioid use and moderate-to-severe PACU pain with dexmedetomidine-based opioid-sparing analgesia and fentanyl-based analgesia during elective craniotomy for brain tumors.

Emergency ICUAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 500 adults. Moderate-to-severe PACU pain occurred in 145 of 242 assessed participants in the fentanyl group and 138 of 233 in the dexmedetomidine group, with no significant difference.

Key takeaways

Intraoperative rescue fentanyl use did not differ significantly between groups.
Hypotension was more common with dexmedetomidine, while postoperative shivering was less common.
Other in-hospital outcomes were similar between the two regimens.

Why this matters on shift

An opioid-sparing label did not translate into better early pain control in this trial, and the differing hypotension and shivering profiles remain relevant during perioperative handoff and recovery monitoring.

Bedside takeaway

Monitor pain, hemodynamics, sedation, and shivering in relation to the analgesic regimen and local protocol.

Nursing implications

During PACU and postoperative handoff, monitor pain, hemodynamics, sedation, and shivering according to the administered regimen and local protocol.

Limitations & cautions

Abstract-only summary. The trial involved elective tumor craniotomy at five Indian centers, both groups also received locoregional analgesia, and the abstract does not provide longer-term outcome results in detail.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of neurosurgical anesthesiology (PubMed). Opioid-Sparing Versus Opioid-Based Analgesia for Craniotomy: A Multicenter Randomized Controlled Trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Journal of neurology (PubMed)Sep 6, 2026Systematic Review

A cumulative meta-analysis found longer survival over time in Duchenne muscular dystrophy, alongside a shift from predominantly respiratory toward cardiac causes of death.

Peds ICUAI summaryReview source

Systematic ReviewResearchPatient EducationAI summary · original source linked below

The review included 53 studies and more than 13,000 patients. Pooled median survival was 29 years among ventilated patients and 19 years among non-ventilated patients, but these study-level observational comparisons do not establish that ventilation alone caused the difference.

Key takeaways

Sixty percent of patients in the included studies received home mechanical ventilation.
Survival improved progressively over time in both ventilated and non-ventilated groups.
As respiratory survival improved, cardiac and other causes accounted for a larger share of deaths.

Why this matters on shift

Patients living longer with Duchenne muscular dystrophy may need sustained respiratory support plus ongoing cardiac and multisystem surveillance across care transitions.

Bedside takeaway

Verify each patient's established respiratory and cardiac plan during admissions and care transitions.

Nursing implications

During admissions and handoffs, verify the established ventilation, airway-clearance, and cardiac-monitoring plan and coordinate concerns with the multidisciplinary team.

Limitations & cautions

Abstract-only summary. This was a study-level meta-analysis of heterogeneous observational survival reports; the ventilated and non-ventilated groups were not randomized, so associations should not be interpreted as treatment effects.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of neurology (PubMed). Improving survival in Duchenne muscular dystrophy across eras: a systematic review and cumulative meta-analysis.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

IV pantoprazole did not improve vomiting or oral tolerance in pediatric gastroenteritis

Dexmedetomidine did not improve early pain outcomes versus fentanyl for craniotomy

Duchenne survival has improved as respiratory and cardiac care evolved