Page 98 - JSOM Fall 2024

may be an asset when assessing and treating this life-threaten- criteria were penetrating injury with systolic blood pressure
ing condition. This can be brought to the role 1 setting as TEG (SBP) <70 or <90mmHg with a heart rate (HR) >110. Patients
is becoming more portable and accessible. with blunt injuries, isolated traumatic brain injury, and cardiac
arrest were excluded. Patients were categorized by first access
Every Minute Matters: A Comparison of IV vs IO Access to type (IV vs. IO) and compared. Primary outcomes of interest
Achieve Timely Transfusion Following Penetrating Trauma were in-hospital mortality and prehospital timing intervals.
Piehl M , Broome JM , Dransfield T , Marino M , Duchesne J 4 Results: A total of 62 patients (32 IV, 30 IO) were included
3
3
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1 WakeMed Health and Hospitals, Raleigh, NC for analysis. The study cohort was predominantly African
2 Medstar Georgetown Washington Hospital Center, Wash- American (97%) and male with a median (IQR) age of 32
ington, DC (24–40). No differences in demographics were observed be-
3 New Orleans Emergency Medical Services, New Orleans, tween groups. Vital signs on initial EMS evaluation (SBP, HR,
LA shock index) did not differ between groups. Median time from
4 Tulane University School of Medicine, Department of Sur- EMS arrival to blood administration did not differ between
gery, New Orleans, LA groups (7 vs. 6min, P=.88). Intervals from EMS scene arrival
to hospital arrival were similar between groups (16 vs. 15min,
Introduction: Prehospital transfusion improves trauma out- P=.67). Median new injury severity score (NISS) and body
comes in military and civilian air medical rescue. Recently, the region Abbreviated Injury Scale (AIS) did not differ between
first study demonstrating a mortality benefit for blood trans- groups. Both 24-hour mortality (6% vs. 7%, P=.83) and total
fusion in civilian ground emergency medical services (EMS) in-hospital mortality (9% vs. 10%, P=.74) were similar be-
was published, demonstrating that advanced resuscitative care tween groups.
(ARC) can be effectively provided for penetrating trauma in
fast-past urban EMS environments. Since 50% of patients Conclusions: Early blood transfusion can save lives in chaotic
in that study had intraosseous (IO) access, we hypothesized urban EMS environments with short transport intervals. Our
that prehospital transfusion via IO or intravenous (IV) routes data demonstrate that patients with severe penetrating trauma
would provide similar survival benefit for patients with severe had similarly low mortality and short transport times when
hemorrhage. rapid blood transfusion was provided via IV or IO routes. This
has important implications for choice of initial vascular access
Methods: This was a single-year, prospective study of ARC
bundle administration in an urban EMS system with 70,000 in the prehospital management of patients with penetrating
annual responses. The ARC bundle included 2U packed red trauma with hemorrhagic shock.
blood cells, tranexamic acid, and calcium. Administration
PMID: 39292948; DOI: 10.55460/BKC3-PW0B

96 | JSOM Volume 24, Edition 3 / Fall 2024