Are the life-saving interventions really life-saving?

Abstract

Several interventions are generally thought to be 'life-saving' in the management and care of traumatically injured patients. The evidence supporting the utility of some interventions, however, is tenuous, if not outright contradictory to what occurs in the modern practice of trauma care. This was the topic of the Point Counterpoint 2024 Charles C. Wolferth lecture given by Nicholas Namias. This article will summarize his talk by highlighting multiple examples of interventions felt to be critical to the preservation of life in the trauma patient that, upon closer inspection, are not as well supported by evidence as one might think. These interventions include the expansion of trauma systems, sternotomy for hemopericardium, resuscitative endovascular balloon occlusion of the aorta (REBOA), prehospital intubation, and needle decompression of traumatic pneumothorax. By discussing the controversy surrounding these interventions, we hope to prompt the reader to question not only the nature and utility of their continued use but also what other closely held ideas and interventions deserve renewed scrutiny.

Keywords: Sternotomy; Systems Analysis; Thoracic Injuries; intubation.