Circulation-first trauma resuscitation and mortality: A 9-year single-center retrospective study.

BACKGROUND

Recent studies have proposed revising the conventional airway-breathing-circulation (ABC) sequence to a circulation-airway-breathing (CAB) approach. We evaluated the potential benefit of the CAB sequence, emphasizing the timing of blood transfusion in trauma resuscitation.

METHODS

We retrospectively analyzed data from the trauma registry and electronic medical records at our institution between March 2016 and February 2024. Adult trauma patients with systolic blood pressure of <90 mm Hg in the resuscitation room who underwent both endotracheal intubation and blood transfusion within 1 hour of arrival were included. To control for confounding factors, including demographics, vital signs, Injury Severity Score, and head/neck Abbreviated Injury Scale, logistic regression analysis was performed after propensity score matching.

RESULTS

A total of 690 patients met the inclusion criteria: 244 received transfusion before intubation (CAB group), and 446 were intubated before transfusion (ABC group). After propensity score matching, 231 patients were included in each group. Intubation occurred 14 minutes earlier, and transfusion occurred 11 minutes later in the ABC group than in the CAB group. Postintubation hypotension was more frequent in the ABC group (73% vs. 64%; p = 0.046), whereas unplanned intensive care unit admission was higher in the CAB group. The median hospital stay was shorter in the ABC group (25 [7-50] days) than in the CAB group (30 [14-50] days) ( p = 0.014). In multivariable analysis, CAB resuscitation was independently associated with reduced 30-day mortality (adjusted odds ratio, 0.57; 95% confidence interval, 0.33-0.99; p = 0.045).

CONCLUSION

This study demonstrated that transfusion-first resuscitation (CAB) improved hemodynamic stability and 30-day survival compared with the conventional ABC sequence. Prioritizing circulation before airway management may reduce postintubation hypotension and guide future trauma resuscitation strategies. Further prospective multicenter studies are warranted to validate these findings.

LEVEL OF EVIDENCES: Therapeutic/Care Management; Level III.