An observational study of pre-hospital central venous access for patients with haemorrhagic shock due to major trauma
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Pallavicini,Paolo;Carenzo,Luca;Adams,Ryan;Bird,Flora;Davenport,Ross;Greenhalgh,Robert;Wood,Andrew E.;Gallagher,Jack;Williams,Sara;Newland,Daryl;Lockey,David J.;Perkins,Zane B.;Ter Avest,Ewoud;Exsanguination Working Group
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2025
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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. METHODS: 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. RESULTS: 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: 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.; When someone is badly hurt and losing a lot of blood very quickly, their life is in serious danger. One important part of early treatment is to give them blood quickly through a drip. Usually, this is done through a vein in the arm, but sometimes this is not possible. In those cases, doctors can put in a special large tube called a trauma line into a big vein in the body. This can be done before the patient gets to the hospital and can help save their life. This study looked back at cases to see how well a 14†Fr trauma line worked for people who were bleeding a lot after a serious injury, before they reached the hospital. The researchers checked patient records to see if it worked, what happened to the patients and if there were any problems. From January 2019 to July 2023, London's Air Ambulance helped 8104 patients. A trauma line was tried in 346 of them (about 4%), and it went in successfully in 276 patients (80%). When the trauma line worked, patients got more blood before reaching the hospital (about 4 units on average compared to 2 units when it didn't work). More people with a successful trauma line were alive when they reached the hospital (54% compared to 36%). Out of those taken to hospital, problems happened in eight people (about 4%). These included the trauma line being in the wrong place (three people); damage to blood vessels (two people); a collapsed lung (two people); and germs on the tip of the line (one person). The study found that putting in a trauma line before getting to hospital is possible, has a low risk of problems and can help give more blood to badly injured patients. This might help more people survive until they reach the hospital.
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Anaesthesia