Impact of Prehospital Exsanguinating Airway-Breathing-Circulation Resuscitation Sequence on Patients with Severe Hemorrhage

Authors

Joseph Ritondale, Tulane University School of Medicine, New Orleans, LA
Mark Piehl, University of North Carolina at Chapel Hill, Chapel Hill, NC
Sydney Caputo, Tulane University School of Medicine, New Orleans, LA
Jacob Broome, MedStar Georgetown Washington Hospital Center, Washington DC
Bryant McLafferty, Tulane University School of Medicine, New Orleans, LA
Augustus Anderson, Tulane University School of Medicine, New Orleans, LA
Cameron Belding, Tulane University School of Medicine, New Orleans, LA
Danielle Tatum, Tulane University School of Medicine, New Orleans, LA
Juan Duchesne, Tulane University School of Medicine, New Orleans, LA
Sharven Taghavi, Tulane University School of Medicine, New Orleans, LA
Patrick McGrew, Tulane University School of Medicine, New Orleans, LA
Kevin Harrell, Tulane University School of Medicine, New Orleans, LA
Olan Jackson-Weaver, Tulane University School of Medicine, New Orleans, LA
Alison Smith, LSU Health Sciences Center - New OrleansFollow
Meg Marino, New Orleans Emergency Medical Services, New Orleans, LA
Tom Dransfield, New Orleans Emergency Medical Services, New Orleans, LA

Document Type

Article

Publication Date

3-15-2024

Publication Title

Journal of the American College of Surgeons

Abstract

BACKGROUND: At the 2023 ATLS symposium, the priority of circulation was emphasized through the "x-airway-breathing-circulation (ABC)" sequence, where "x" stands for exsanguinating hemorrhage control. With growing evidence from military and civilian studies supporting an x-ABC approach to trauma care, a prehospital advanced resuscitative care (ARC) bundle emphasizing early transfusion was developed in our emergency medical services (EMS) system. We hypothesized that prioritization of prehospital x-ABC through ARC would reduce in-hospital mortality. STUDY DESIGN: This was a single-year prospective analysis of patients with severe hemorrhage. These patients were combined with our institution's historic controls before prehospital blood implementation. Included were patients with systolic blood pressure (SBP) less than 90 mmHg. Excluded were patients with penetrating head trauma or prehospital cardiac arrest. Two-to-one propensity matching for x-ABC to ABC groups was conducted, and the primary outcome, in-hospital mortality, was compared between groups. RESULTS: A total of 93 patients (x-ABC = 62, ABC = 31) met the inclusion criteria. There was no difference in patient age, sex, initial SBP, initial Glasgow Coma Score, and initial shock index between groups. When compared with the ABC group, x-ABC patients had significant improvement in vitals at emergency department admission. Overall mortality was lower in the x-ABC group (13% vs 47%, p < 0.001). Multivariable regression revealed that prehospital circulation-first prioritization was independently associated with decreased in-hospital mortality (odds ratio 0.15, 95% CI 0.04 to 0.54, p = 0.004). CONCLUSIONS: This is the first analysis to demonstrate a prehospital survival benefit of x-ABC in this subset of patient with severe injury and hemorrhagic shock. Standardization of prehospital x-ABC management in this patient population warrants special consideration.

First Page

367

Last Page

373

PubMed ID

38197435

Volume

238

Issue

4

Recommended Citation

Ritondale, Joseph; Piehl, Mark; Caputo, Sydney; Broome, Jacob; McLafferty, Bryant; Anderson, Augustus; Belding, Cameron; Tatum, Danielle; Duchesne, Juan; Taghavi, Sharven; McGrew, Patrick; Harrell, Kevin; Jackson-Weaver, Olan; Smith, Alison; Marino, Meg; and Dransfield, Tom, "Impact of Prehospital Exsanguinating Airway-Breathing-Circulation Resuscitation Sequence on Patients with Severe Hemorrhage" (2024). School of Medicine Faculty Publications. 2487.
https://digitalscholar.lsuhsc.edu/som_facpubs/2487
10.1097/XCS.0000000000000956