Prioritizing circulation over airway to improve survival in trauma patients with exsanguinating injuries: a world society of emergency surgery-panamerican trauma consensus statement.
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Ferrada Paula, Shafique Saima, Brenner Megan, Burlew Clay, Catena Fausto, Coleman Julia, Coleman Jamie, Demetriades Demetrios, Demoya Marc, Di Saverio Salomone, Dissanaike Sharmila, Dransfield Tom, DuBose Joseph, Duchesne Juan, Elkbuli Adel, Foianini Esteban, Gambardella Josephine, Garcia Alberto, Goldberg Amy, Goralnick Eric, Holcomb John, Jonathan Messing, Joseph Bellal, Jacobs Lenworth, Kerby Jeffrey, Lawerance Robert, Leichtle Stefan, Lucas Charles, Machain Gustavo, Macleod Jana, Maher Zoe, Martin Matthew, Mendez Napoleon, Menegozzo Carlos, Merlini Ilenia, Namias Nicholas, Narayan Mayur, Ordonez Carlos, Ottolino Pablo, Patel Mayur, Qasim Zaffer A, Quiodettis Martha, Young LeAnne Sitari, Ratnasekera Ashanti, Rayburn David, Salamea Juan, Sarani Babak, Scalea Thomas, Seamon Mark, Spain David, Steele Portia, Taghavi Sharven, Tatebe Leah, Vega Felipe, Velmahos George, Zakrison Tanya, Biffl Walter L, Damaskos Dimitrios, Coccolini Federico, Vallicelli Carlo, Moore Ernest E, Ansaloni Luca, Kluger Yoram
Аннотация
METHODS: A systematic review was conducted in accordance with the PRISMA guidelines. Databases including PubMed and Ovid MEDLINE, SCOPUS, web of science and EMBASE were searched for studies published up to September 2024. Eligible studies included observational and comparative studies reporting outcomes of trauma patients with exsanguinating hemorrhage. The Newcastle-Ottawa Scale was used for risk of bias assessment. A meta-analysis was performed using a random-effects model to calculate pooled odds ratios (OR) for mortality, with 95% confidence intervals (CI). Subgroup analysis was conducted to compare the ABC and CAB approaches in prospective and retrospective studies.
RESULTS: Six studies (N = 11,855 patients) met the inclusion criteria. The meta-analysis revealed a significant increase in mortality associated with the ABC approach (pooled OR: 3.65, 95% CI: 1.74-7.65). Subgroup analysis of prospective cohort studies found an even higher mortality risk (POR: 9.99, 95% CI: 5.59-17.85) when compared with POR of retrospective studies (POR: 2.42, 95%CI: 1.08-5.36). High heterogeneity (I2 = 92%) was observed across the studies, likely due to variations in patient populations and resuscitation protocols.
CONCLUSION: Prioritizing circulation over airway management in trauma patients with exsanguinating injuries significantly reduces mortality compared to the traditional ABC approach. The present consensus paper, conducted according to the WSES methodology3, aims to provide a review of the literature comparing the CAB approach to the traditional ABC sequence in trauma patients with exsanguinating hemorrhage, to develop a shared consensus statement based on the currently available evidence.