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    Circulation first - the time has come to question the sequencing of care in the ABCs of trauma; an American Association for the Surgery of Trauma multicenter trial

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    Author
    Ferrada, P.
    Callcut, R.A.
    Skarupa, D.J.
    Date
    2018
    Journal
    World Journal of Emergency Surgery
    Publisher
    BioMed Central Ltd.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.1186/s13017-018-0168-3
    Abstract
    Background: The traditional sequence of trauma care: Airway, Breathing, Circulation (ABC) has been practiced for many years. It became the standard of care despite the lack of scientific evidence. We hypothesized that patients in hypovolemic shock would have comparable outcomes with initiation of bleeding treatment (transfusion) prior to intubation (CAB), compared to those patients treated with the traditional ABC sequence. Methods: This study was sponsored by the American Association for the Surgery of Trauma multicenter trials committee. We performed a retrospective analysis of all patients that presented to trauma centers with presumptive hypovolemic shock indicated by pre-hospital or emergency department hypotension and need for intubation from January 1, 2014 to July 1, 2016. Data collected included demographics, timing of intubation, vital signs before and after intubation, timing of the blood transfusion initiation related to intubation, and outcomes. Results: From 440 patients that met inclusion criteria, 245 (55.7%) received intravenous blood product resuscitation first (CAB), and 195 (44.3%) were intubated before any resuscitation was started (ABC). There was no difference in ISS, mechanism, or comorbidities. Those intubated prior to receiving transfusion had a lower GCS than those with transfusion initiation prior to intubation (ABC: 4, CAB:9, p = 0.005). Although mortality was high in both groups, there was no statistically significant difference (CAB 47% and ABC 50%). In multivariate analysis, initial SBP and initial GCS were the only independent predictors of death. Conclusion: The current study highlights that many trauma centers are already initiating circulation first prior to intubation when treating hypovolemic shock (CAB), even in patients with a low GCS. This practice was not associated with an increased mortality. Further prospective investigation is warranted. Copyright 2018 The Author(s).
    Keyword
    Circulation
    Circulation first
    Effects of intubation
    Hypotension and resuscitation
    Hypotension in trauma
    Hypovolemia and hypotension
    Resuscitation
    Resuscitation in trauma
    Trauma
    Trauma resuscitation
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85041409739&doi=10.1186%2fs13017-018-0168-3&partnerID=40&md5=b61b83e77b4b95b6e417de0918ad083a; http://hdl.handle.net/10713/9719
    ae974a485f413a2113503eed53cd6c53
    10.1186/s13017-018-0168-3
    Scopus Count
    Collections
    UMB Open Access Articles 2018

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