Faster Refill in an Urban EMS System Saves Lives: A Prospective Preliminary Evaluation of a Prehospital Advanced Resuscitative Care Bundle.

MedStar author(s):
Citation: The Journal of Trauma and Acute Care Surgery. 2024 Jan 08PMID: 38189675Department: MedStar General Surgery Residency | MedStar Georgetown University Hospital/MedStar Washington Hospital CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXED | Year: 2024Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 2163-0755
Name of journal: The journal of trauma and acute care surgeryAbstract: CONCLUSION: Early ARC in a fast-paced urban EMS system is achievable and may improve physiologic derangements while decreasing patient mortality. ARC closer to the point of injury warrants consideration.INTRODUCTION: Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian EMS systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality.LEVEL OF EVIDENCE: Level IV, Prospective. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.METHODS: This was a prospective analysis of ARC bundle administration between 2021 and 2023 in an urban EMS system with 70,000 annual responses. The ARC bundle consisted of calcium, tranexamic acid (TXA), and PRBCs via a rapid infuser. ARC patients were compared to trauma registry controls from 2016 to 2019. Included were patients with a penetrating injury and SBP < 90 mmHg. Excluded were isolated head trauma or prehospital cardiac arrest. In-hospital mortality was the primary outcome of interest.RESULTS: A total of 210 patients (ARC = 61, controls = 149) met criteria. Median age was 32 years, with no difference in demographics, initial SBP or heart rate recorded by EMS, or new injury severity score (NISS) between groups. At hospital arrival, ARC patients had lower median heart rate and shock index than controls (p < 0.03). Fewer patients in the ARC group required prehospital advanced airway placement (p < 0.001). 24-hour and total in-hospital mortality were lower in the ARC group (p < 0.04). Multivariable regression revealed an independent reduction in in-hospital mortality with ARC (OR 0.19, 95%CI 0.05-0.68, p = 0.01).All authors: Broome JM, Nordham KD, Piehl M, Tatum D, Caputo S, Belding C, De Maio VJ, Taghavi S, Jackson-Weaver O, Harris C, McGrew P, Smith A, Nichols E, Dransfield T, Rayburn D, Marino M, Avegno J, Duchesne JFiscal year: FY2024Digital Object Identifier: Date added to catalog: 2024-04-24
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 38189675 Available 38189675

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSION: Early ARC in a fast-paced urban EMS system is achievable and may improve physiologic derangements while decreasing patient mortality. ARC closer to the point of injury warrants consideration.

INTRODUCTION: Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian EMS systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality.

LEVEL OF EVIDENCE: Level IV, Prospective. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

METHODS: This was a prospective analysis of ARC bundle administration between 2021 and 2023 in an urban EMS system with 70,000 annual responses. The ARC bundle consisted of calcium, tranexamic acid (TXA), and PRBCs via a rapid infuser. ARC patients were compared to trauma registry controls from 2016 to 2019. Included were patients with a penetrating injury and SBP < 90 mmHg. Excluded were isolated head trauma or prehospital cardiac arrest. In-hospital mortality was the primary outcome of interest.

RESULTS: A total of 210 patients (ARC = 61, controls = 149) met criteria. Median age was 32 years, with no difference in demographics, initial SBP or heart rate recorded by EMS, or new injury severity score (NISS) between groups. At hospital arrival, ARC patients had lower median heart rate and shock index than controls (p < 0.03). Fewer patients in the ARC group required prehospital advanced airway placement (p < 0.001). 24-hour and total in-hospital mortality were lower in the ARC group (p < 0.04). Multivariable regression revealed an independent reduction in in-hospital mortality with ARC (OR 0.19, 95%CI 0.05-0.68, p = 0.01).

English

Powered by Koha