TRAUMA QUALITY IMPROVEMENT
Moving the needle on time to resuscitation using trauma video review
Published on
April 4, 2023
Journal of Trauma and Acute Care Surgery
Overview
In a multicenter trial evaluating vascular access methods in hypotensive trauma patients, researchers compared intraosseous (IO) access, peripheral intravenous (PIV) access, and central venous catheter (CVC) access. The study included 1,410 access attempts across 581 patients, revealing that IO access had a significantly higher success rate (93%) compared to PIV (67%) and CVC (59%). The median time to establish any access was 5.0 minutes, with IO access being as fast as PIV but notably quicker than CVC. Furthermore, patients who received IO access experienced a shorter time to resuscitation initiation, particularly in those without prior access. The findings suggest that IO access should be prioritized as a first-line approach in hypotensive trauma situations due to its superior success rate and efficiency.
Results
There were 1,410 access attempts that occurred in 581 patients with a median age of 40 years (27-59 years) and an Injury Severity Score of 22 [10-34]. Nine hundred thirty-two PIV, 204 IO, and 249 CVC were attempted. Seventy percent of access attempts were successful but were significantly less likely to be successful in females (64% vs. 71%, p = 0.01). Median time to any access was 5.0 minutes (3.2-8.0 minutes). Intraosseous had higher success rates than PIV or CVC (93% vs. 67% vs. 59%, p < 0.001) and remained higher after subsequent failures (second attempt, 85% vs. 59% vs. 69%, p = 0.08; third attempt, 100% vs. 33% vs. 67%, p = 0.002). Duration varied by access type (IO, 36 [23-60] seconds; PIV, 44 [31-61] seconds; CVC 171 [105-298]seconds) and was significantly different between IO versus CVC ( p < 0.001) and PIV versus CVC ( p < 0.001) but not PIV versus IO. Time to resuscitation initiation was shorter in patients whose initial access attempt was IO, 5.8 minutes versus 6.7 minutes ( p = 0.015). This was more pronounced in patients arriving to the hospital with no established access (5.7 minutes vs. 7.5 minutes, p = 0.001).
