IV access in bleeding trauma patients: a performance review.

Area of Science:

• Trauma Care
• Emergency Medicine
• Vascular Access

Background:

• Exsanguinating hemorrhage is a leading cause of death in trauma patients.
• Effective management requires hemostasis, volume replacement, and coagulopathy treatment.
• Vascular access is critical for fluid and blood product administration.

Purpose of the Study:

• To examine the nature and timing of achieving adequate intravenous (IV) access.
• To assess the impact of IV access on prehospital times and blood transfusion initiation.

Main Methods:

• Retrospective chart review of trauma patients transfused with uncrossmatched blood.
• Analysis of prehospital times and time to first packed red blood cell (PRBC) transfusion.
• Comparison of outcomes based on prehospital IV access versus no prehospital IV access.

Main Results:

• 81% of patients received prehospital IV access, increasing on-scene time by 5 minutes.
• Patients without prehospital IVs had a 21-minute delay in adequate IV access post-trauma bay arrival.
• Central venous catheter placement strongly correlated with time to first blood transfusion (r=0.94, p<0.001).

Conclusions:

• Prehospital IV access is common but associated with longer EMS on-scene times.
• Prehospital IVs did not correlate with more rapid blood product transfusion initiation.
• Optimizing IV access remains a challenge for timely transfusion in severely injured patients.