An observational study of pre-hospital central venous access for patients with haemorrhagic shock due to major trauma

Abstract

Introduction: Exsanguinating haemorrhagic shock due to major trauma is associated with high mortality. Rapid intravenous volume replacement with blood products is a crucial element of early treatment. When peripheral intravenous access cannot be obtained, pre-hospital placement of a large-calibre central venous catheter, known as a trauma line, can be a life-saving alternative. Method(s): This was a retrospective cohort study to evaluate the feasibility, efficacy and safety profile of inserting a 14-Fr trauma line in patients with exsanguinating haemorrhage due to major trauma in the pre-hospital setting. Success rates, outcomes and complications of trauma line insertion were determined by cross-referencing pre-hospital patient care records with emergency department notes, operating notes and post-mortem findings. Result(s): Between 1 January 2019 and 31 July 2023, London's Air Ambulance attended 8104 patients. Trauma line insertion was attempted in 346 (4%) patients with success in 276 (80%). Successful trauma line insertion was associated with significantly greater transfusion of pre-hospital blood products compared with those in whom insertion was unsuccessful (median (IQR range]) 4 (2-6 0-12]) vs. 2 (0-4 0-8]) units, respectively; p < 0.001). Survival to presentation to the emergency department was higher after successful trauma line insertion (149/279 (54%) vs. 25/70 (36%); p = 0.006). There were 184 (53%) patients transported to hospital. Complications in this group were reported in 8 (4%) patients: malpositioned trauma line (n = 3); vascular injuries (n = 2); iatrogenic pneumothorax (n = 2); and positive trauma line tip culture (n = 1). Discussion(s): In patients with exsanguinating haemorrhage who are in severe shock or traumatic cardiac arrest, pre-hospital trauma line insertion is feasible and associated with an acceptable risk of procedural complications. Trauma lines enable the delivery of a greater volume of blood products in the pre-hospital setting, which may be associated with increased pre-hospital survival.Copyright © 2025 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.