Hemorrhage is a major cause of preventable trauma deaths, and the ABC approach is widely used during the primary survey. We hypothesize that prioritizing circulation over intubation (CAB) can improve outcomes in patients with exsanguinating injuries. A prospective observational study involving international trauma centers was conducted. Patients with systolic blood pressure below 90 who were intubated within 30 min of arrival were included. Prioritizing circulation (CAB) was defined as delaying intubation until blood products were started, and/or bleeding control was performed before securing the airway. Demographics, clinical data, and outcomes were recorded. The study included 278 eligible patients, with 61.5% falling within the “CAB” cohort and 38.5% in the “ABC” cohort. Demographic and disease characteristics, including age, sex, ISS, use of blood products, and other relevant factors, exhibited comparable distributions between the two cohorts. The CAB group had a higher proportion of penetrating injuries and more patients receiving intubation in the operating room. Notably, patients in the CAB group demonstrated higher GCS scores, lower SBP values before intubation but higher after intubation, and a significantly lower incidence of cardiac arrest and post-intubation hypotension. Key outcomes revealed significantly lower 24-hour mortality in the CAB group (11.1% vs. 69.2%), a lower rate of renal failure, and a higher rate of ARDS. Multivariable logistic regression models showed a 91% reduction in the odds of mortality within 24 h and an 89% reduction at 30 days for the CAB cohort compared to the ABC cohort. These findings suggest that prioritizing circulation before intubation is associated with improved outcomes in patients with exsanguinating injuries. Post-intubation hypotension is observed to be correlated with worse outcomes. The consideration of prioritizing circulation over intubation in patients with exsanguinating injuries, allowing for resuscitation, or bleeding control, appears to be associated with potential improvements in survival. Emphasizing the importance of circulation and resuscitation is crucial, and this approach might offer benefits for various bleeding-related conditions.

中文翻译：

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比较失血损伤患者的结局：东部创伤外科协会 (EAST) 的多中心国际试验评估循环优先于插管（CAB 优于 ABC）


出血是可预防的创伤死亡的主要原因，ABC 方法在初步调查中被广泛使用。我们假设优先循环而不是插管 (CAB) 可以改善失血损伤患者的预后。进行了一项涉及国际创伤中心的前瞻性观察研究。收缩压低于 90 并在到达后 30 分钟内插管的患者也被纳入其中。优先循环（CAB）被定义为延迟插管，直到开始使用血液制品和/或在确保气道安全之前进行出血控制。记录人口统计、临床数据和结果。该研究纳入了 278 名符合条件的患者，其中 61.5% 属于“CAB”队列，38.5%属于“ABC”队列。人口统计学和疾病特征，包括年龄、性别、ISS、血液制品的使用和其他相关因素，在两个队列之间表现出相似的分布。 CAB组发生穿透伤的比例较高，且在手术室接受插管的患者较多。值得注意的是，CAB 组患者表现出较高的 GCS 评分、插管前较低的 SBP 值但插管后较高，并且心脏骤停和插管后低血压的发生率显着降低。主要结果显示，CAB 组的 24 小时死亡率显着降低（11.1% vs. 69.2%）、肾衰竭发生率较低、ARDS 发生率较高。多变量逻辑回归模型显示，与 ABC 队列相比，CAB 队列 24 小时内死亡率降低了 91%，30 天死亡率降低了 89%。这些发现表明，插管前优先考虑循环与失血损伤患者预后的改善相关。 据观察，插管后低血压与较差的结局相关。对于失血性损伤的患者，考虑优先进行循环而不是插管，以便进行复苏或控制出血，似乎与潜在的生存改善有关。强调循环和复苏的重要性至关重要，这种方法可能对各种出血相关疾病有好处。