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

Area of Science:

• Emergency Medicine
• Trauma Resuscitation
• Critical Care

Background:

• The conventional airway-breathing-circulation (ABC) sequence for trauma resuscitation is being challenged.
• A shift towards a circulation-airway-breathing (CAB) approach is proposed, focusing on early blood transfusion.
• This study evaluates the benefits of the CAB sequence in trauma care.

Purpose of the Study:

• To assess the impact of prioritizing blood transfusion (CAB) over intubation (ABC) on trauma patient outcomes.
• To determine if the CAB sequence improves hemodynamic stability and survival rates.
• To analyze the effect of resuscitation sequence on post-intubation hypotension and hospital stay.

Main Methods:

• Retrospective analysis of adult trauma patients with severe hypotension (SBP <90 mm Hg) from March 2016 to February 2024.
• Inclusion criteria: endotracheal intubation and blood transfusion within 1 hour of arrival.
• Propensity score matching was used to control for confounding factors and compare CAB vs. ABC groups.

Main Results:

• After matching, 231 patients were in each group (CAB vs. ABC).
• The CAB group showed improved hemodynamic stability and a shorter hospital stay.
• CAB resuscitation was independently associated with reduced 30-day mortality (aOR 0.57; p=0.045).

Conclusions:

• Transfusion-first resuscitation (CAB) enhances hemodynamic stability and 30-day survival compared to the ABC sequence.
• Prioritizing circulation may mitigate post-intubation hypotension.
• Findings support the CAB approach for future trauma resuscitation strategies, pending further validation.