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Prehospital Care

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Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial.
Moore HB, Moore EE, Chapman MP, McVaney K, Bryskiewicz G, Blechar R, Chin T, Burlew CC, Pieracci F, West FB, Fleming CD, Ghasabyan A, Chandler J, Silliman CC, Banerjee A, Sauaia A.
2018 Jul 28;392(10144):283-291.

Rationale for inclusion: 125 patients were randomized to plasma or saline prehospital resuscitation groups.  No survival benefit was realized in this urban, rapid transport prehospital setting.

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Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock.
Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, Adams PW, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Witham WR, Putnam AT, Duane TM, Alarcon LH, Callaway CW, Zuckerbraun BS, Neal MD, Rosengart MR, Forsythe RM, Billiar TR, Yealy DM, Peitzman AB, Zenati MS; PAMPer Study Group.
2018 Jul 26;379(4):315-326.

Rationale for inclusion: 501 patients enrolled in this prospective, multicenter, cluster-randomized clinical trial.  Patients administered thawed plasma in the prehospital setting had lower 24hr and 30 day mortality.

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Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury.
Teixeira PGR, Brown CVR, Emigh B, Long M, Foreman M, Eastridge B, Gale S, Truitt MS, Dissanaike S, Duane T, Holcomb J, Eastman A, Regner J; Texas Tourniquet Study Group.
2018 May;226(5):769-776.e1.

Rationale for inclusion: Multicenter retrospective review of over 1000 patients with peripheral vascular injuries.  Prehospital tourniquet use in 181 patients was associated with 6 fold reduction in mortality.

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Prehospital spine immobilization/spinal motion restriction in penetrating trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST).
Velopulos CG, Shihab HM, Lottenberg L, Feinman M, Raja A, Salomone J, Haut ER.
2018 May;84(5):736-744.

Rationale for inclusion: EAST PMG utilizing GRADE methodology recommends against the routine use of spine immobilazation for adults with penetrating injuries.

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Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services.
Wandling MW, Nathens AB, Shapiro MB, Haut ER.
2018 Feb 1;153(2):107-113. doi: 10.1001/jamasurg.2017.3601.

Rationale for inclusion: 2 years of NTDB data was analyzed to determine that private vehicle transport was associated with improved survival compared to EMS transport in urban America.

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The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock.
Scerbo MH, Holcomb JB, Taub E, Gates K, Love JD, Wade CE, Cotton BA.
2017 Dec;83(6):1165-1172. doi: 10.1097/TA.0000000000001666.

Rationale for inclusion: Single center study comparing patients with major limb trauma who had tourniquets placed either in the prehospital or trauma center settings.  Delaying tourniquet placement until the trauma center was associated with decreased blood pressure, increased transfusion requirements and increased mortality.

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Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial.
Bulger EM, May S, Kerby JD, Emerson S, Stiell IG, Schreiber MA, Brasel KJ, Tisherman SA, Coimbra R, Rizoli S, Minei JP, Hata JS, Sopko G, Evans DC, Hoyt DB; ROC investigators.
Ann Surg. 2011 Mar;253(3):431-41.

Rationale for inclusion: Randomized study of hypertonic saline/dextran to normal saline, showed no difference in mortality and a higher mortality for the post-randomization group of patients who did not receive transfusions and received hypertonic fluids.

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Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial.
Bernard SA, Nguyen V, Cameron P, Masci K, Fitzgerald M, Cooper DJ, Walker T, Std BP, Myles P, Murray L, David, Taylor, Smith K, Patrick I, Edington J, Bacon A, Rosenfeld JV, Judson R.
Ann Surg. 2010 Dec;252(6):959-65.

Rationale for inclusion: RCT showed improved neurologic outcome for patients who received paramedic RSI versus hospital intubation.

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Spine immobilization in penetrating trauma: more harm than good?
Haut ER, Kalish BT, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE 3rd, Chang DC.
J Trauma. 2010 Jan;68(1):115-20; discussion 120-1.

Rationale for inclusion: NTDB study of 45,000 patients. Prehospital spine immobilization is associated with higher mortality in penetrating trauma and should not be routinely used in every patient with penetrating trauma.

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The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity.
Stiell IG, Nesbitt LP, Pickett W, Munkley D, Spaite DW, Banek J, Field B, Luinstra-Toohey L, Maloney J, Dreyer J, Lyver M, Campeau T, Wells GA; OPALS Study Group.
CMAJ. 2008 Apr 22;178(9):1141-52.

Rationale for inclusion: Systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9.

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Out-of-hospital endotracheal intubation and outcome after traumatic brain injury.
Wang HE, Peitzman AB, Cassidy LD, Adelson PD, Yealy DM.
Ann Emerg Med. 2004 Nov;44(5):439-50.

Rationale for inclusion: Out-of-hospital endotracheal intubation was associated with adverse outcomes after severe traumatic brain injury. 

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Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial.
Cooper DJ, Myles PS, McDermott FT, Murray LJ, Laidlaw J, Cooper G, Tremayne AB, Bernard SS, Ponsford J; HTS Study Investigators.
JAMA. 2004 Mar 17;291(11):1350-7.

Rationale for inclusion: In this study, patients with hypotension and severe TBI who received prehospital resuscitation with HTS had almost identical neurological function 6 months after injury as patients who received conventional fluid.

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The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury.
Davis DP, Hoyt DB, Ochs M, Fortlage D, Holbrook T, Marshall LK, Rosen P.
J Trauma. 2003 Mar;54(3):444-53.

Rationale for inclusion: Paramedic intubation in the field was associated with higher mortality, possibly from transient hypoxia, inadvertent hyperventilation, and longer scene times.

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Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury.
Bochicchio GV, Ilahi O, Joshi M, Bochicchio K, Scalea TM.
J Trauma. 2003 Feb;54(2):307-11.

Rationale for inclusion: Prehospital intubation is associated with a significant increase in morbidity and mortality in trauma patients with traumatic brain injury who are admitted to the hospital without an acutely lethal injury in prospective data.

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Multicenter Canadian study of prehospital trauma care.
Liberman M, Mulder D, Lavoie A, Denis R, Sampalis JS.
Ann Surg. 2003 Feb;237(2):153-60.

Rationale for inclusion: In urban centers with highly specialized level I trauma centers, there is no benefit in having on-site ALS for the prehospital management of trauma patients.

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Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma.
Sampalis JS, Denis R, Fr├ęchette P, Brown R, Fleiszer D, Mulder D.
J Trauma. 1997 Aug;43(2):288-95; discussion 295-6.

Rationale for inclusion: Transportation of severely injured patients from the scene directly to Level I trauma centers is associated with a reduction in mortality and morbidity. 

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Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma Research and Education Foundation of San Diego.
Winchell RJ, Hoyt DB.
Arch Surg. 1997 Jun;132(6):592-7.

Rationale for inclusion: Prehospital endotracheal intubation was associated with improved survival in patients with blunt injury and scene Glasgow Coma Score of 8 or less, especially those with severe head injury by anatomic criteria. 

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Paramedic vs private transportation of trauma patients. Effect on outcome.
Demetriades D, Chan L, Cornwell E, Belzberg H, Berne TV, Asensio J, Chan D, Eckstein M, Alo K.
Arch Surg. 1996 Feb;131(2):133-8.

Rationale for inclusion: Comparison of EMS to non-EMS patients, showing an increased mortality in the EMS group.

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Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients.
Sampalis JS, Lavoie A, Williams JI, Mulder DS, Kalina M.
J Trauma. 1993 Feb;34(2):252-61.

Rationale for inclusion: 360 patient sample; there was no association with survival for use of advanced life support. Prehospital time over 60 minutes was associated with an increased risk of dying.

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Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial.
Mattox KL, Maningas PA, Moore EE, Mateer JR, Marx JA, Aprahamian C, Burch JM, Pepe PE.
Ann Surg. 1991 May;213(5):482-91.

Rationale for inclusion: RCT of HSD to normal crystalloid solution showing no difference in survival but fewer complications in the HSD group.

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Prehospital stabilization of critically injured patients: a failed concept.
Smith JP, Bodai BI, Hill AS, Frey CF.
J Trauma. 1985 Jan;25(1):65-70.

Rationale for inclusion: Review of 52 hypotensive trauma patients; transport time to hospital was less than time to establish an IV. Supports "Scoop and Run."

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