Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries

E Ter Avest; L Carenzo; R A Lendrum; M D Christian; R M Lyon; C Coniglio; M Rehn; D J Lockey; Z B Perkins

doi:10.1186/s13054-022-04052-7

Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries

Crit Care. 2022 Jun 20;26(1):184. doi: 10.1186/s13054-022-04052-7.

Authors

E Ter Avest^{1

2

3}, L Carenzo^{4

5}, R A Lendrum^{4

6}, M D Christian^{4

7

8}, R M Lyon^{9

10}, C Coniglio¹¹, M Rehn^{12

13

14}, D J Lockey^{4

15}, Z B Perkins^{4

16}

Affiliations

¹ London's Air Ambulance and Bart's Health NHS Trust, Royal London Hospital, 17th floor, London, E1 1FR, UK. e.teravest@nhs.net.
² Air Ambulance Kent Surrey and Sussex, Hanger 10 Redhill Aerodrome, Redhill, UK. e.teravest@nhs.net.
³ Department of Emergency Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. e.teravest@nhs.net.
⁴ London's Air Ambulance and Bart's Health NHS Trust, Royal London Hospital, 17th floor, London, E1 1FR, UK.
⁵ Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
⁶ Department of Perioperative Medicine, St Bartholomew's Hospital, London, UK.
⁷ BC Emergency Health Services, Provincial Health Services Authority, Vancouver, BC, Canada.
⁸ Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁹ Air Ambulance Kent Surrey and Sussex, Hanger 10 Redhill Aerodrome, Redhill, UK.
¹⁰ School of Health Sciences, University of Surrey, Surrey, UK.
¹¹ Department of Anesthesia, Intensive Care and Pre-Hospital Emergency Medical Services, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
¹² The Norwegian Air Ambulance Foundation, Oslo, Norway.
¹³ Air Ambulance Department, Oslo University Hospital, Oslo, Norway.
¹⁴ Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
¹⁵ Queen Mary University, London, UK.
¹⁶ Centre for Trauma Sciences, Queen Mary University of London, London, UK.

Abstract

Early haemorrhage control and minimizing the time to definitive care have long been the cornerstones of therapy for patients exsanguinating from non-compressible haemorrhage (NCH) after penetrating injuries, as only basic treatment could be provided on scene. However, more recently, advanced on-scene treatments such as the transfusion of blood products, resuscitative thoracotomy (RT) and resuscitative endovascular balloon occlusion of the aorta (REBOA) have become available in a small number of pre-hospital critical care teams. Although these advanced techniques are included in the current traumatic cardiac arrest algorithm of the European Resuscitation Council (ERC), published in 2021, clear guidance on the practical application of these techniques in the pre-hospital setting is scarce. This paper provides a scoping review on how these advanced techniques can be incorporated into practice for the resuscitation of patients exsanguinating from NCH after penetrating injuries, based on available literature and the collective experience of several helicopter emergency medical services (HEMS) across Europe who have introduced these advanced resuscitation interventions into routine practice.

Keywords: Helicopter emergency medical services (HEMS); Interventions; Penetrating injuries; Pre-hospital.

Publication types

Review

MeSH terms

Balloon Occlusion* / methods
Endovascular Procedures* / methods
Hemorrhage / etiology
Hemorrhage / therapy
Hospitals
Humans
Resuscitation / methods