Emphasising circulation over the airway in trauma situations with severe bleeding could significantly enhance patient outcomes.
This is according to a compilation of research findings and clinical trials.
This alternative resuscitation strategy focuses on stopping bleeding and restoring circulation as a priority, diverging from the traditional method that prioritises restoring the airway first.
The approach is highlighted in a literature review published in the Journal of the American College of Surgeons.
It suggests that for trauma patients experiencing substantial blood loss, directing attention toward halting the bleeding and reinstating circulation initially rather than immediately securing the airway can positively impact survival rates and overall results.
A comprehensive analysis conducted by researchers from various institutions in the US and Colombia affirms the viability of prioritising circulation in trauma patients suffering from massive bleeding.
This shift in trauma care represents a more time-efficient approach that can substantially influence survival, especially in regions with limited medical resources where every second counts.
Dr Paula Ferrada, the lead author of the study and a professor at the University of Virginia, stresses the significance of prioritising circulation for patients with severe bleeding.
She suggests that delaying intubation and focusing on alternative measures to support the airway, such as oxygen and airway manipulation, can make a critical difference in life-saving moments.
The research, involving a team of 12 surgeons from 10 different institutions, reviewed existing literature comparing the conventional airway-breathing-circulation (ABC) approach to the newer circulation-airway-breathing (CAB) model.
Drawing upon extensive clinical experience, the review promotes the notion that prioritising circulation is pivotal for patients with exsanguinating haemorrhage, challenging the traditional ABC approach.
This review synthesised multiple meta-analyses and trials, revealing that patients in haemorrhagic shock are more susceptible to circulatory collapse under the ABC approach and require circulatory resuscitation before intubation.
Dr Ferrada underscores that the ABC approach lacks concrete evidence and is based more on expert consensus than empirical data.
Recent protocol shifts have favoured prioritising circulation, initially witnessed in nontraumatic cardiac arrest cases, and now, this review advocates for a similar approach in trauma patients with severe blood loss.
Moreover, empirical evidence cited in the review indicates a lower mortality rate in CAB compared to ABC.
Studies highlighted within the review exhibit mortality rates of 12.4% for CAB versus 23% for ABC, with a meta-analysis showcasing worsened mortality following a sharp drop in blood pressure post-intubation: 19.6% for CAB versus 33.2% for ABC.
The CAB approach aligns with the American College of Surgeons’ STOP THE BLEED programme, emphasising prompt training and interventions to address bleeding through various medical procedures like direct pressure, wound packing, and tourniquet use.
Dr Ferrada suggested further prospective studies will validate the mortality differences between the two approaches, emphasising the importance of continuous research in supporting the CAB approach.
