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

被引：33

作者：

Ferrada, Paula ^{[1
]}

Callcut, Rachael A. ^{[2
]}

Skarupa, David J. ^{[3
]}

Duane, Therese M. ^{[4
]}

Garcia, Alberto ^{[5
]}

Inaba, Kenji ^{[6
]}

Khor, Desmond ^{[6
]}

Anto, Vincent ^{[7
]}

Sperry, Jason ^{[7
]}

Turay, David ^{[8
]}

Nygaard, Rachel M. ^{[9
]}

Schreiber, Martin A. ^{[10
]}

Enniss, Toby ^{[11
]}

McNutt, Michelle ^{[12
]}

Phelan, Herb ^{[13
]}

Smith, Kira ^{[13
]}

Moore, Forrest O. ^{[14
]}

Tabas, Irene ^{[15
]}

Dubose, Joseph ^{[16
]}

机构：

[1] Virginia Commonwealth Univ, Trauma Emergency Surg & Crit Care, 417 N 11th St, Richmond, VA 23298 USA

[2] Univ Calif San Francisco, San Francisco, CA 94143 USA

[3] Univ Florida, Coll Med, Gainesville, FL USA

[4] John Peter Smith Hosp Network, Ft Worth, TX USA

[5] Fdn Valle Lili Hosp, Ctr Invest Clin, Cali, Colombia

[6] Univ Southern Calif, Los Angeles, CA 90089 USA

[7] Univ Pittsburgh, Pittsburgh, PA 15260 USA

[8] Loma Linda Univ, Loma Linda, CA 92350 USA

[9] Hennepin Cty Med Ctr, Minneapolis, MN 55415 USA

[10] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[11] Univ Utah, Sch Med, Salt Lake City, UT USA

[12] Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Houston, TX 77030 USA

[13] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA

[14] Chandler Reg Med Ctr, Chandler, AZ USA

[15] Univ Texas Austin, Dell Med Sch, Austin, TX 78712 USA

[16] Univ Maryland, Shock Trauma Ctr, Baltimore, MD 21201 USA

来源：

WORLD JOURNAL OF EMERGENCY SURGERY | 2018年 / 13卷

关键词：

Trauma resuscitation; Circulation first; Effects of intubation; Resuscitation in trauma; Trauma; Resuscitation; Circulation; Hypovolemia and hypotension; Hypotension in trauma; Hypotension and resuscitation; HOSPITAL CARDIAC-ARREST; CONTINUOUS CHEST COMPRESSIONS; CARDIOPULMONARY-RESUSCITATION; ENDOTRACHEAL INTUBATION; PREHOSPITAL INTUBATION; HEMODYNAMIC-RESPONSES; TRACHEAL INTUBATION; BRAIN-INJURY; LARYNGOSCOPY; PRESSURE;

D O I：

10.1186/s13017-018-0168-3

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页数：6

共 28 条

[1] Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury [J].