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applying inclusion/exclusion criteria, four studies were included in and 2019. Patients were stratified based on prehospital LTOWB
the review and metaanalysis which identified a significant survival transfusion (PHT) or no prehospital transfusion (NT). Outcomes
benefit in patients who received prehospital TXA versus no TXA. measured included emergency department (ED), 6h and hospital
Three observational cohort and one randomized control trial were mortality, change in shock index (SI), and incidence of massive
included into the review with a total of 2,347 patients (TXA, 1,169 transfusion. Statistical analyses were performed. Results: A total
vs. no TXA, 1,178). There was a significant reduction in 24 hours of 538 patients met inclusion criteria. Patients undergoing PHT
mortality; odds ratio (OR) of 0.60 (95% confidence interval [CI], had worse shock physiology (median SI 1.25 vs. 0.95, p < 0.001)
0.37–0.99). No statistical significant differences in 28 days to with greater reversal of shock upon arrival (–0.28 vs. –0.002,
30 days mortality; OR of 0.69 (95% CI, 0.47–1.02), or venous p < 0.001). In a propensitymatched group of 214 patients with
thromboembolism OR of 1.49 (95% CI, 0.90–2.46) were found. prehospital shock, 58 patients underwent PHT and 156 did not.
Conclusion: This review demonstrates that prehospital TXA is as Demographics were similar between the groups. Mean improve
sociated with significant reductions in the early (24hour) mortal ment in SI between scene and ED was greatest for patients in
ity of trauma patients with suspected or confirmed hemorrhage but the PHT group with a lower trauma bay mortality (0% vs. 7%,
no increase in the incidence of venous thromboembolism. p = 0.04). No survival benefit for patients in prehospital cardiac
arrest receiving LTOWB was found (p > 0.05). Discussion: This
High Success Rate of Prehospital and En Route study demonstrated that trauma patients who received prehospital
Cricothyroidotomy Performed in the Israel Defense LTOWB transfusion had a greater improvement in SI and a re
Forces: 20 Years of Experience duction in early mortality. Patient with prehospital cardiac arrest
Eran Beit Ner, Avishai M. Tsur, Roy Nadler, Elon Glassberg, did not have an improvement in survival. These findings support
Avi Benov, Jacob Chen LTOWB use in the prehospital setting. Further multiinstitutional
Prehosp Disaster Med. 2021;36(6):713–718. prospective studies are needed.
Introduction: Securing the airway is a crucial stage of trauma Prehospital End-Tidal Carbon Dioxide Predicts
care. Cricothyroidotomy (CRIC) is often addressed as a salvage Hemorrhagic Shock Upon Emergency Department Arrival
procedure in complicated cases or following a failed endotracheal Natalie Bulger, Brenna Harrington, Josh Krieger,
intubation (ETI). Nevertheless, it is a very important skill in pre Andrew Latimer, Saman Arbabi, Catherine R. Counts,
hospital settings, such as on the battlefield. Hypothesis/problem: Michael Sayre, Charles Maynard, Eileen M. Bulger
This study aimed to review the Israel Defense Forces (IDF) expe J Trauma Acute Care Surg. 2021;91(3):457–464.
rience with CRIC over the past two decades. Methods: The IDF
Trauma Registry (IDFTR) holds data on all trauma casualties Background: In addition to reflecting gas exchange within the
(civilian and military) cared for by military medical teams since lungs, endtidal carbon dioxide (EtCO ) also reflects cardiac out
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1997. Data of all casualties treated by IDF from 1998 through put based on CO delivery to the pulmonary parenchyma. We
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2018 were extracted and analyzed to identify all patients who hypothesized that low prehospital EtCO values would be pre
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underwent CRIC procedures. Variables describing the incident dictive of hemorrhagic shock in intubated trauma patients. Meth-
scenario, patient’s characteristics, injury pattern, treatment, and ods: A retrospective observational study of adult trauma patients
outcome were extracted. The success rate of the procedure was intubated in the prehospital setting and transported to a single
described, and selected variables were further analyzed and com Level I trauma center from 2016 to 2019. Continuous prehospital
pared using the Fisher’sexact test to identify their effect on the EtCO data were linked with patient care registries. We developed
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success and failure rates. Odds Ratio (OR) was further calculated a novel analytic approach that allows for reflection of prehospi
for the effect of different body part involvement on success and tal EtCO over the entire prehospital course of care. The primary
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for the mortality after failed ETI. Results: One hundred fiftythree outcome was hemorrhagic shock on emergency department (ED)
casualties on which a CRIC attempt was made were identified presentation, defined as either initial ED systolic blood pressure of
from the IDFTR records. The overall success rate of CRIC was 90mmHg or less or initial Shock Index (SI) > 0.9, and transfusion
reported at 88%. In patients who underwent one or two attempts, of at least one unit of blood product during their ED stay. Pre
the success rate was 86%. No difference was found across pro hospital EtCO less than 25mmHg was evaluated for predictive
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viders (physician versus paramedic). The CRIC success rates for value of hemorrhagic shock. Results: Three hundred and seven
casualties with and without head trauma were 80% and 92%, patients (82% men, 34% penetrating injury, 42% in hemorrhagic
respectively (P = 0.06). Overall mortality was 33%. Conclusion: shock on ED arrival, 27% mortality) were included in the study.
This study shows that CRIC is of merit in airway management as Patients in hemorrhagic shock had lower median EtCO values
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it has shown to have consistently high success rates throughout (26.5mmHg vs. 32.5mmHg; p < 0.001) than those not in hemor
different levels of training, injuries, and previous attempts with rhagic shock. Patients with prehospital EtCO less than 25mmHg
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ETI. Care providers should be encouraged to retain and develop were 3.0 times (adjusted odds ratio = 3.0; 95% confidence inter
this skill as part of their toolbox. val, 1.1–7.9) more likely to be in hemorrhagic shock upon ED ar
rival than patients with EtCO ≥ 25mmHg. Conclusion: Intubated
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Prehospital Whole Blood Reduces Early Mortality patients with hemorrhagic shock upon ED arrival had significantly
in Patients With Hemorrhagic Shock lower prehospital EtCO values. Incorporating EtCO assessment
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Maxwell A. Braverman, Alison Smith, Douglas Pokorny, into prehospital care for trauma patients could support decisions
Benjamin Axtman, Charles Patrick Shahan, Lauran Barry, regarding prehospital blood transfusion, and triage to higherlevel
Hannah Corral, Rachelle Babbitt Jonas, Michael Shiels, trauma centers, and trauma team activation.
Randall Schaefer, Eric Epley, Christopher Winckler,
Elizabeth Waltman, Brian J. Eastridge, Susannah E. Nicholson, An Analysis of Prehospital Trauma Registry
Ronald M. Stewart, Donald H. Jenkins After-Action Reviews in Afghanistan
Transfusion. 2021;61 Suppl 1:S15–S21. Brandon M. Carius, Peter M. Dodge, Andrew D. Fisher,
Paul E. Loos, Dominic Thompson, Steven G. Schauer
Background: Low titer O+ whole blood (LTOWB) is being in J Spec Oper Med. Summer 2021;21(2):49–53.
creasingly used for resuscitation of hemorrhagic shock in military
and civilian settings. The objective of this study was to identify Background: Afteraction reviews (AARs) in the Prehospital
the impact of prehospital LTOWB on survival for patients in Trauma Registry (PHTR) enable performance improvements
shock receiving prehospital LTOWB transfusion. Study design and provide commanders feedback on care delivered at Role
and methods: A single institutional trauma registry was queried 1. No published data exist exploring overall trends of enduser
for patients undergoing prehospital transfusion between 2015 performanceimprovement feedback. Methods: We performed an
TCCC and ERCCC Journal Watch Abstracts | 137
