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

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.

PMID: 35725641
PMCID: PMC9210796
DOI: 10.1186/s13054-022-04052-7

Review

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

E Ter Avest et al. Crit Care. 2022.

. 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.

PMID: 35725641
PMCID: PMC9210796
DOI: 10.1186/s13054-022-04052-7

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.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Traumatic cardiac arrest (TCA)

**Fig. 2**
Options for cardiac resuscitation of patients in traumatic cardiac arrest (TCA) due to non-compressible haemorrhage from non-ballistic penetrating injuries: Addition to the 2021 ERC guidelines [15] on the treatment of patients in traumatic cardiac arrest (original figure adapted with permission)

**Fig. 3**
REBOA options for pre-hospital haemorrhage control and cardiac resuscitation for patients in haemorrhagic shock due to non-compressible penetrating injuries

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources