Trauma Resuscitation Research Articles

Ionised calcium levels during trauma resuscitation in predicting outcomes-a prospective cohort study.

Haemorrhage remains the leading cause of preventable mortality following trauma, often aggravated by the acidosis, hypothermia and coagulopathy-the lethal triad of trauma. However, the impact of trauma-induced hypocalcemia on the haemorrhage remains unclear. It is intuitive to consider perturbations of ionised calcium early during trauma resuscitation in acutely injured patients given its pathophysiological significance for an improved outcome. Thus, we conducted a prospective study to analyse the role of ionized calcium ion levels during trauma resuscitation and its association with the need for blood transfusion(s) requirement and mortality. A prospective study was conducted on acutely injured patients with haemorrhage getting admitted to a Level 1 trauma center in India between September 2020 and June 2022. Ionised calcium was measured on arrival, after 6h, and on day two of the injury to assess the prevalence. The amount of blood transfusion received by the patient was noted along with other demographic and in-hospital details. The association of hypocalcemia with blood transfusion and mortality was also evaluated. Of the 1961 patients screened for eligibility, 200 patients were recruited and analysed. 72.5% of patients were hypocalcaemic on emergency department (ED) admission. Ionized hypocalcaemia was significantly associated with the need for blood transfusion(s) (p-value < 0.01). A significant association was also noted between ionized hypocalcaemia and mortality (p-value: 0.0085). On the univariate and multivariable analysis, ionized hypocalcaemia was a significant predictor of mortality. Ionized hypocalcaemia is widely prevalent among acutely injured. Trauma-induced hypocalcaemia at admission is associated with increased need for blood transfusions and increased mortality.

Addressing Teamwork Delays during Life-Saving Interventions through an Activity Theory-Informed Analysis

Hemorrhage, or severe blood loss due to injury, is a leading cause of preventable deaths after injury. This study uses and extends activity theory to understand the dynamics of team-based hemorrhage control during trauma resuscitation and to explore potential computerized mechanisms to support this time- and safety-critical process. We reviewed videos of 25 resuscitation cases and analyzed hemorrhage control activities using nine activity theory prompts, including a new prompt-speech intention-a critical but underexplored dimension of teamwork in prior activity theory analyses. Through this process, we identified the most common delay-causing activities and developed routine and non-routine activity models for each. A comparison of these models showed that variations from the routine models emerged due to changes in the division of labor, instruments, community, and speech intentions. We contribute to research on designing socio-technical systems by (1) identifying needs and opportunities for computerized support that address delays in complex medical teamwork and (2) examining how an intervention changes an activity model. We also show how adding detailed speech data aids in identifying contradictions between elements in an activity model.

Human intention recognition for trauma resuscitation: An interpretable deep learning approach for medical process data.

Trauma resuscitation is the initial evaluation and management of injured patients in the emergency department. This time-critical process requires the simultaneous pursuit of multiple resuscitation goals. Recognizing whether the required goal is being pursued can reduce errors in goal-related task performance and improve patient outcomes. The intention to pursue a goal can often be inferred from ongoing and completed treatment activities, but monitoring goal pursuit is cognitively demanding and prone to errors. We introduced an interpretable deep learning-based approach to aid decision making by automatically recognizing goal pursuit during trauma resuscitation. We developed a predictive model to recognize the pursuit of two resuscitation goals: airway stabilization and circulatory support. We used event logs of 381 pediatric trauma resuscitations from August 2014 to November 2022 to train a neural network model with a dual-GRU structure that learns from both time-level and activity-type-level features. Our model makes predictions based on a sequence of activities and corresponding timestamps. To enhance the model and facilitate interpretation of predictions, we used the attention weights assigned by our model to represent the importance of features. These weights identified the critical time points and contributing activities during a goal pursuit. Our model achieved an average area under the receiver operating characteristic curve (AUC) score of 0.84 for recognizing airway stabilization and 0.83 for recognizing circulatory support. The most contributing activities and timestamps were aligned with domain knowledge. Our interpretable predictive model can recognize provider intention based on a limited number of treatment activities. The model outperformed existing predictive models for medical events in accuracy and in interpretability. Integrating our model into a decision-support system would automate the tracking of provider actions, optimizing workflow to ensure timely delivery of care.

European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Vascular Trauma.

The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with vascular trauma with the aim of assisting physicians in selecting the optimal management strategy. The guidelines are based on scientific evidence completed with expert opinion. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to the ESVS evidence grading system, where the strength (class) of each recommendation is graded from I to III, and the letters A to C mark the level of evidence. A total of 105 recommendations have been issued on the following topics: general principles for vascular trauma care and resuscitation including technical skill sets, bleeding control and restoration of perfusion, graft materials, and imaging; management of vascular trauma in the neck, thoracic aorta and thoracic outlet, abdomen, and upper and lower extremities; post-operative considerations after vascular trauma; and paediatric vascular trauma. In addition, unresolved vascular trauma issues and the patients' perspectives are discussed. The ESVS clinical practice guidelines provide the most comprehensive, up to date, evidence based advice to clinicians on the management of vascular trauma.

What, When, and Why: Viscoelastic Hemostatic Assays and Their Uses in Trauma Resuscitation.

Viscoelastic hemostatic assays (VHAs) have become a valuable tool in guiding transfusion therapy, particularly in trauma care. While various forms of VHA exist, all provide a quantitative assessment of clot kinetics, strength, and dissolution. Studies have demonstrated that VHA can reduce both mortality and utilization of blood products in the general population. Interpreting VHA results requires consideration of specific patient factors, such as age and altered physiological properties as in pregnancy and the process of aging. Further research is needed to establish accurate reference ranges for these specific populations. This review article provides a comprehensive overview of the technical aspects of VHA as well as their clinical uses in trauma resuscitation.

Evolving patterns of first blood product use in trauma in the era of hemorrhage control resuscitation.

We reviewed trauma blood use at our US regional trauma center 2011-2022-including PROPPR trial participation 2012-2014 and initiation of whole blood availability in 2019-to assess the implementation of early coagulation support in acute trauma care. We identified all acute trauma patients recorded by our Trauma Registry as arriving at our large US regional Level 1 trauma center from April 6, 2011 (Blood Bank opening) through December 2022. Patient cohort data were then linked directly to Blood Bank final-product-issue date/time data to identify patients receiving any blood product in the first 24 h of care and then, specifically, at least one unit of Red Blood Cells (RBC), Plasma, or Whole Blood (WB). Results were binned as: "RBC first," "Plasma first," "Both at the same time," or "WB first." Over the study period, 73,634 acute trauma patients received care, and 12,927 received at least one unit of a blood product. The proportion receiving plasma or a combination of plasma and RBCs as the initial transfusion increased after 2015 from 33% to 66%, while the proportion receiving packed RBCs alone decreased from 57% to about 18%. Since its introduction in 2019, the use of WB as the first product has grown to 20%. This retrospective cohort study documents the increasing use of plasma and now WB as initial products issued in trauma resuscitation, reflecting acceptance of coagulation support as the standard of care and the use of hemostatic resuscitation protocols.

PREBOA versus ER-REBOA impact on blood utilization and resuscitation requirements: A pilot analysis.

Partial occlusion of the aorta is a resuscitation technique designed to maximize proximal perfusion while allowing a graduated amount of distal flow to reduce the ischemic sequelae associated with complete aortic occlusion. The pREBOA-PRO catheter affords the ability to titrate perfusion as hemodynamics allows; however, the impact of this new technology for resuscitative endovascular balloon occlusion of the aorta (REBOA) on blood use and other resuscitative requirements is currently unknown. We hypothesize that patients undergoing REBOA with the pREBOA-PRO catheter will utilize partial occlusion, when appropriate, and decrease overall resuscitative requirements when compared to patients undergoing REBOA with the ER-REBOA catheter. The entire American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry was used to compare resuscitation requirements between all ER-REBOA and pREBOA. Unpaired t tests were used to compare resuscitation strategies including packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, cryoprecipitate, crystalloids, and need for pressors. When comparing ER-REBOA (n = 800) use to pREBOA (n = 155), initial patient presentations were similar except for age (44 years vs. 40 years, p = 0.026) and rates of blunt injury (78.4% vs. 78.7% p < 0.010). Zone 1 occlusion was used less often in ER-REBOA (65.8 vs. 71.7, p = 0.046). Partial occlusion was performed in 85% of pREBOA compared with 11% in ER-REBOA ( p < 0.050). Vitals at the time of REBOA were worse in ER-REBOA and received significantly more units of PRBCs, FFP, platelets, and liters of crystalloids than pREBOA ( p < 0.05). Rates of ARDS and septic shock were lower in pREBOA ( p < 0.05). When comparing pREBOA to ER-REBOA, there has been a rise in Zone 1 and partial occlusion. In our pilot analysis of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry, there was a reduction in administration of PRBCs, FFP, platelets, and crystalloids. Although further prospective studies are required, this is the first to demonstrate an association between pREBOA, partial occlusion, and reduced blood use and resuscitative requirements. Therapeutic/Care Management; Level IV.

Immersive Virtual Reality Versus Mannequin-based Simulation Training for Trauma Resuscitation: A Randomized Controlled Noninferiority Trial.

Despite its high potential, the effect of immersive virtual reality simulation (VRS) in trauma resuscitation training has not been studied. The aim of this study was to test the hypothesis that VRS is non-inferior to mannequin-based simulation (MBS) in trauma resuscitation training. In a single-center, randomized controlled noninferiority trial, we compared individual training with an immersive virtual reality Trauma Simulator to live MBS training in a facilitated group. The primary outcome was the Trauma Score (ranging from 55 to 177) during the MBS assessment. The secondary outcomes were the Trauma Score VRS assessment, System Usability Scale (SUS) (ranging from 0 to 100), and Simulation Sickness Questionnaire (SSQ) (ranging from 0 to 235.62). A total of 38 participants were enrolled in the study. The mean Trauma Score in MBS assessment was 163.2 (SD 7.9) for the control group and 163.1 (SD 13.8) for the intervention group; the difference of means 0.1 (95% confidence interval: -7.3, 7.5; P = .977). The mean Trauma Score in VRS assessment was 134.2 (SD 24.4) for control group and 158.4 (SD 17.6) for intervention group; the difference of means 24.2 (95% confidence interval: 10.1, 38.3; P = .001). The mean SUS of Trauma Simulator was 74.4 (SD 10.5). The median SSQ Total Severity score was 3.7 (IQR 0-18.7). This study showed that VRS led to noninferior effects on trauma resuscitation skills to MBS. Trauma Simulator had good usability, was well received by the participants, and had minimal adverse effects.

Evolution of whole blood trauma resuscitation in childbearing age females: practice patterns and trends

BackgroundThe use of low titer group O whole blood (LTOWB) for resuscitation of patients with traumatic hemorrhage is becoming increasingly common. Practices regarding the administration of RhD-positive LTOWB to childbearing...

The Unbefriended Patient, Their Professional Guardians, and Clinical Liaison Psychiatry: The Challenging Ethics of Changing Goals of Care.

AbstractUnbefriended patients are those with decisional impairments who lack family or friends to serve as healthcare surrogates. When such patients cannot make decisions, the court typically appoints a professional guardian to make choices aligned with the patient's values and preferences. However, this case report illustrates ethical challenges that can arise when professional guardians disregard the patient's authentic wishes. In this case study, the 38-year-old unbefriended African American male patient expressed fears about traumatic resuscitation efforts and ultimately desired de-escalation of care, which the guardian was hesitant to honor despite confirmed decision-making capacity. The guardian quickly reversed a new do-not-resuscitate order when the patient later changed his mind. Decisions about aggressive interventions like a colostomy were significantly delayed while awaiting final judgments involving the guardian's supervisors and the judicial system. The case highlights pitfalls with guardians defaulting to treatment escalation without sufficiently engaging with ethical standards or eliciting the patient's narrative identity, leading to inconsistent surrogate decisions. We propose that more robust reforms are needed, including enhanced training of guardians in ethical decision-making, and we present other means to facilitate best practices in proxy decision-making.

Prehospital Trauma Compendium: Fluid Resuscitation in Trauma – a Position Statement and Resource Document of NAEMSP

Fluid resuscitation choices in prehospital trauma care are limited, with most Emergency Medical Services (EMS) agencies only having access to crystalloids. Which solution to use, how much to administer, and judging the individual risks and benefits of giving or withholding fluids remains an area of uncertainty. To address the role of crystalloid fluids in prehospital trauma care, we reviewed the available relevant literature and developed recommendations to guide clinical care. The topic of prehospital blood product administration is covered elsewhere. NAEMSP recommends Isotonic crystalloid solutions should be the preferred fluids for use in prehospital trauma management. Specific choice of isotonic crystalloid solutions may be driven by medication compatibility and other operational issues. Permissive hypotension is reasonable in patients without traumatic brain injury (TBI). Avoiding or correcting hypotension in polytrauma patients with TBI may be a higher priority than restricting fluid use. Large volume crystalloid resuscitation should be generally avoided. Developing processes to administer warmed intravenous (IV) fluids is reasonable. Risks of IV fluid use, or restriction, in trauma resuscitation should be weighed against possible benefits. Strategies to reduce the need for IV fluids should be considered. A standard trauma resuscitation curriculum for prehospital providers should be developed to improve evidence-based delivery of IV fluids in trauma.

Early crystalloid resuscitation in Trauma: How much is too much? Insights from a National Trauma Registry

BackgroundCrystalloid administration during early resuscitation of bleeding trauma patients is recommended by current guidelines, yet evidence supporting this practice is limited. We aimed to evaluate the trends in the utilization of crystalloids during the last decade and to determine the threshold crystalloid volume independently associated with mortality risk in trauma patients at risk of or experiencing shock. MethodsA retrospective cohort study using data from the Israel National Trauma Registry (January 2013 to December 2022) was conducted. We included patients ≥16-years-old transported by emergency medical services from the injury scene and subsequently hospitalized. Inclusion criteria included systolic blood pressure < 90 mmHg and/or shock index >1 in the field or emergency department (ED). Patients transferred between facilities, those who received prehospital blood products, or those who suffered burns were excluded. The primary outcome was all-cause in-hospital mortality. Multivariable logistic regression was performed to investigate the association between the total volume of crystalloid administered during prehospital and ED treatment and the primary outcome, adjusting for clinical variables. ResultsAmong 10,707 eligible patients, the median age was 39.0 years (IQR 25.0–65.0), 63.5 % were male, and 81.4 % suffered from blunt trauma, mainly caused by motor vehicle collisions. There was a trend toward reduced crystalloid use over the study period both prehospital and in the ED. Crystalloid volumes ≥2 liters were independently associated with increased mortality with an aOR of 1.47 (95 % CI 1.09–1.96, p = 0.01) for 2000–2499 ml and an aOR of 1.49 (95 % CI 1.08–2.04, p = 0.01) for ≥2500 ml. Older age, male gender, lower blood pressure, and severe injury (ISS >15) were also independently associated with higher mortality. ConclusionThe administration of ≥2 liters of crystalloids during the initial phase of care was independently associated with increased mortality in hemodynamically compromised trauma patients. These findings support the judicious and goal-directed use of crystalloids in the resuscitation of trauma patients.

The Trauma Training Score: A Novel and Objective Method for Performance Evaluation.

Assessing proficiency in the initial management of a traumatically injured patient is challenging. Previously developed scoring tools frequently looked to evaluate single domains of a trauma leader or team's performance. An updated multi-domain scoring tool is needed to evaluate individual and group performance in the initial phases of trauma resuscitation. The modified Delphi technique was used to improve and obtain consensus on a multi-domain trauma training score (TTS). Subject matter experts (SMEs) in trauma across the United States were contacted electronically to consider voluntary participation in this study. Elective participants electronically received and commented on statements related to the 10 separate domains of a proposed TTS. These statements were evaluated using a 5-point Likert scale ranging from "Strongly Agree" to "Strongly Disagree". Feedback from the SMEs was used to modify each domain that did not receive consensus, and repeat iterations were performed until 80% or greater consensus was achieved.Internal consistency was measured usingCronbach's-ɑ, with a goal of greater than 0.8. Twenty-eight SMEs elected to participatein the modified Delphi processrepresenting emergency medicine, trauma surgery, and critical care. Consensus was achieved when 80% or greater of the SMEs responded with a 4 or a 5 to each statement. Four total rounds of review and modification were required to achieve consensus on all statements.Cronbach's-ɑfor each round was greater than 0.85. A unifying standardized outcome for measuring performance in the initial phases of trauma resuscitation is needed.The TTS developed in this study usedexpert consensustoprovide a multi-domain means of evaluating trauma practitioners of all levels in both live and simulated patients.

Comparison of virtual and in-person simulations for sepsis and trauma resuscitation training in Singapore: a randomized controlled trial.

This study aimed to compare cognitive, non-cognitive, and overall learning outcomes for sepsis and trauma resuscitation skills in novices with virtual patient simulation (VPS) versus in-person simulation (IPS). A randomized controlled trial was conducted on junior doctors in emergency departments from January to December 2022, comparing 70 minutes of VPS (n=19) versus IPS (n=21) in sepsis and trauma resuscitation. Using the nominal group technique, we created skills assessment checklists and determined Bloom's taxonomy domains for each checklist item. Two blinded raters observed participants leading 1 sepsis and 1 trauma resuscitation simulation. Satisfaction was measured using the Student Satisfaction with Learning Scale (SSLS). The SSLS and checklist scores were analyzed using the 2-tailed t-test. For sepsis, there was no significant difference between VPS and IPS in overall scores (2.0; 95% confidence interval [CI], -1.4 to 5.4; Cohen's d=0.38), as well as in items that were cognitive (1.1; 95% CI, -1.5 to 3.7) and not only cognitive (0.9; 95% CI, -0.4 to 2.2). Likewise, for trauma, there was no significant difference in overall scores (-0.9; 95% CI, -4.1 to 2.3; Cohen's d=0.19), as well as in items that were cognitive (-0.3; 95% CI, -2.8 to 2.1) and not only cognitive (-0.6; 95% CI, -2.4 to 1.3). The median SSLS scores were lower with VPS than with IPS (-3.0; 95% CI, -1.0 to -5.0). For novices, there were no major differences in overall and non-cognitive learning outcomes for sepsis and trauma resuscitation between VPS and IPS. Learners were more satisfied with IPS than with VPS (clinicaltrials.gov identifier: NCT05201950).

Resuscitation of adult shocked trauma patients using major haemorrhage protocol guided by viscoelastic haemostatic assays versus formulaic approach.

The resuscitation of trauma patients with critical bleeding may follow a formulaic approach using high ratios of blood components or a viscoelastic haemostatic assay (VHA) guided approach. The aim of this study was to compare the two strategies for resuscitation of shocked trauma patients. This was a registry-based cohort study including shocked trauma patients from two trauma centres-one practising a formulaic approach, with VHA unavailable during trauma resuscitation and the other practicing a VHA-guided resuscitation strategy. The primary outcome was the total units of blood components transfused in 24 h after adjusting for differences in baseline characteristics and time to death. Between 01 Jan 2020 and 31 Dec 2022, 152 eligible patients were categorised to the formulaic group and 40 to the VHA group. Prehospital times were longer in the formulaic group (2.0 vs. 1.4 h), and more patients in the VHA group (38% vs. 17%) were transfused prehospital blood components. Formulaic resuscitation was associated with significantly more blood components transfused (adjusted incidence rate ratio 1.5; 95%CI: 1.4-1.7, p < 0.001). Using a formulaic approach, patients were administered more red blood cells, plasma and platelets, but fewer cryoprecipitate. There was no significant association of the formulaic approach with in-hospital mortality (adjusted odds ratio 2.4; 95%CI: 0.7-8.0, p = 0.17). Given the cost and potential adverse effects of blood component transfusions, VHA-guided transfusion strategies present an attractive option, particularly among centres managing high volumes of shocked patients. Further trials, enrolling the population most likely to benefit from precision transfusion strategies, are indicated.

Variations in Trauma Education Practices Across Emergency Medicine Residencies: Insights from a National Survey of Program Directors.

Care of the acutely injured trauma patient is integral to the practice of emergency medicine. It is currently unknown how most emergency medicine residencies structure their residents' trauma experience and little guidance for competency assessment is provided by the Residency Review Committee. Our study aimed to determine current emergency medicine residency practices in trauma resuscitation. We conducted a cross-sectional survey of members of the Council of Residency Directors in Emergency Medicine (CORD) listserv in April 2023. Frequency with percentage of item responses is reported and differences across trauma levels assessed via Fisher's exact test (α = 0.05). Fifty-seven program directors responded to the survey (21.9%), the majority of whom operate at Level I facilities. Significantly more Level II/ III centers send residents to other sites for trauma experience compared to Level I (p = 0.000). Residents participate in all key procedures (eg, airway management, central venous access) when managing traumas except thoracotomy where participation was notably lower and statistically different across levels (p = 0.000). Lastly, program directors were very confident their residents can lead traumas independently and few acknowledged citations for deficiency in trauma training. Trauma training and confirmation of competency is critical among EM residents who may serve as the sole lead in rural emergency departments. This study demonstrates that there is considerable variability in how residency programs structure trauma education, particularly with regards to the exposure to invasive procedures and the opportunity to lead trauma resuscitations. As the American Board of Emergency Medicine has introduced requirements for program directors to attest specifically to the competence of residents to lead trauma resuscitations, standardized and validated tools should be adopted to support this attestation and ensure competence regardless of the program hospital's trauma level.

Every minute matters: Improving outcomes for penetrating trauma through prehospital advanced resuscitative care.

Prehospital resuscitation with blood products is gaining popularity for patients with traumatic hemorrhage. The MEDEVAC trial demonstrated a survival benefit exclusively among patients who received blood or plasma within 15 minutes of air medical evacuation. In fast-paced urban EMS systems with a high incidence of penetrating trauma, mortality data based on the timing to first blood administration is scarce. We hypothesize a survival benefit in patients with severe hemorrhage when blood is administered within the first 15 minutes of EMS patient contact. This was a retrospective analysis of a prospective database of prehospital blood (PHB) administration between 2021 and 2023 in an urban EMS system facing increasing rates of gun violence. Prehospital blood patients were compared with trauma registry controls from an era before prehospital blood utilization (2016-2019). Included were patients with penetrating injury and SBP ≤ 90 mm Hg at initial EMS evaluation that received at least one unit of blood product after injury. Excluded were isolated head trauma or prehospital cardiac arrest. Time to initiation of blood administration before and after PHB implementation and in-hospital mortality were the primary variables of interest. A total of 143 patients (PHB = 61, controls = 82) were included for analysis. Median age was 34 years with no difference in demographics. Median scene and transport intervals were longer in the PHB cohort, with a 5-minute increase in total prehospital time. Time to administration of first unit of blood was significantly lower in the PHB vs. control group (8 min vs. 27 min; p < 0.01). In-hospital mortality was lower in the PHB vs. control group (7% vs. 29%; p < 0.01). When controlling for patient age, NISS, tachycardia on EMS evaluation, and total prehospital time interval, multivariate regression revealed an independent increase in mortality by 11% with each minute delay to blood administration following injury (OR 1.11, 95%CI 1.04-1.19). Compared with patients with penetrating trauma and hypotension who first received blood after hospital arrival, resuscitation with blood products was started 19 minutes earlier after initiation of a PHB program despite a 5-minute increase in prehospital time. A survival for early PHB use was demonstrated, with an 11% mortality increase for each minute delay to blood administration. Interventions such as PHB may improve patient outcomes by helping capture opportunities to improve trauma resuscitation closer to the point of injury. Therapeutic/Care Management; Level IV.

Less is more: Overlapping communication in trauma resuscitation

BackgroundTimely management of trauma patients is crucial. Better team performance means faster care, but roles of specific communication practices remain unclear. We hypothesized that overlapping communication is associated with less efficient resuscitations. MethodsThis single-center prospective observational study included hypotensive trauma patients from June–September 2023. Data were collected using Trauma Video Review. The association between overlapping communication and resuscitation length was assessed using multivariable linear regression adjusting for demographics, injury mechanism, Injury Severity Score (ISS), vitals, and number of procedures performed. ResultsWe included 87 patients with median ISS 26.0 [interquartile range IQR: 14.0–34.0] and median systolic blood pressure 84.0 [70.0–90.5]. Median resuscitation length was 19.1 [15.4–23.1] minutes. Overlapping communication occurred for median 1.22 [0.7–2.1] minutes. Overlapping communication was associated with longer resuscitations (p ​< ​0.0001). ConclusionsOverlapping communication was associated with less efficient resuscitations in hypotensive trauma patients. Training for trauma teams should target “one voice at a time”.

Pelvic Traumas and Hybrid Emergency Medicine System: Literature Review Based on Two Cases

Objective: Bleeding, the most common life-threatening complication of pelvic trauma occurs due to injuries of pelvic arterial and venous structures and bone fractures. The outcomes of patients can be improved by a timely performed angioembolisation (AE). Hybrid Emergency Service System (HERS) has been recently introduced a novel approach which provides trauma resuscitation room equipped with computerized tomography, fluoroscopy, and an operating room, thus effects the outcomes of trauma patients. Cases: We presented two pelvic traumas and in both cases with the most common life-threatening complication was bleeding. In both cases, whole-body computed tomography (WBCT), endovascular procedures (Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), transcatheter arterial embolization (TAE)), and injury control surgery can be simultaneously performed without the need to transport a patient to an operating room which is called HERS resuscitation. Both patients were discharged and remained free of any medical problem at long-term (12 months) follow-up. Conclusion: Considering the recently introduced HERS system in patient management and integrating it into emergency services will be extremely useful in the management of trauma and trauma-induced bleeding.

PARTIAL OCCLUSION, LESS AKI: AN AORTA REGISTRY ANALYSIS OF PREBOA-PRO.

Background: Noncompressible torso hemorrhage remains a leading cause of potentially preventable deaths. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as an adjunct temporizing hemorrhage control. The complete occlusion strategy with the ER-REBOA catheter can cause distal ischemia when used for longer than 30 min. To specifically address this limitation, the pREBOA-PRO catheter was developed. The objective of the current study is to investigate the impact of longer, partial occlusion times provided by pREBOA-PRO on acute kidney injury and mortality. Methods: This is a retrospective analysis of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry as of August 2023. Patients in the pREBOA-PRO group (n = 110) receiving partial occlusion in Zone 1 were contrasted to patients in the ER-REBOA group (n = 752) treated with complete occlusion in Zone 1. Between-group comparisons included demographics, clinical presentation, aortic occlusion strategy, clinical complications, and mortality. Results: Demographics, clinical presentation, and mortality were indistinguishable between groups, except for age which was higher in the ER-REBOA group (44 vs. 38, P < 0.002). The partial aortic occlusion strategy was employed more often in the pREBOA-PRO group (87% vs. 33%, P < 0.05) and for longer periods (59 min vs. 50 min, P < 0.003). In contrast, AKI occurred less frequently in the pREBOA-PRO group (19% vs. 33%, P < 0.05). Conclusions: The more frequently partial and longer occlusion times in Zone 1 with the use of pREBOA-PRO resulted in lower AKI incidence suggesting that this newer device is a safer extended bridge to hemorrhage control.