Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"The association between arrival potassium and 30-day survival following resuscitation from out-of-hospital cardiac arrest: a retrospective cohort study.","authors":"Christina Byrne, Maria Lukacs Krogager, Kristian Kragholm, Manan Pareek, Grimur Høgnason Mohr, Kristian Bundgaard Ringgren, Mads Wissenberg, Signe Riddersholm, Martin Wolder, Fredrik Folke, Gunnar Gislason, Lars Køber, Christian Hassager, Jesper Kjærgaard, Christopher B Fordyce, Christian Torp-Pedersen, Gregory Y H Lip, Carlo A Barcella","doi":"10.1186/s13049-025-01454-8","DOIUrl":"https://doi.org/10.1186/s13049-025-01454-8","url":null,"abstract":"<p><strong>Background: </strong>It is unknown whether there is an association between initial serum potassium level and short-term survival in out-of-hospital cardiac arrest (OHCA) survivors. The aim of this study was to describe potential associations between first recorded potassium level and 30-day survival in patients surviving OHCA.</p><p><strong>Methods: </strong>We identified 4,894 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001-2019. Potassium values were divided into seven predefined levels: < 2.5, 2.5-2.9, 3.0-3.4, 3.5-4.6, 4.7-5.5, 5.5-6.0, > 6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5-4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index (including chronic kidney disease), witnessed status, performance of bystander cardiopulmonary resuscitation (CPR) and first registered heart rhythm.</p><p><strong>Results: </strong>Over the 30-day follow-up period, survival rates in the seven strata were as follows: 25 (51.0%), 119 (53.6%), 512 (65.4%), 1,631 (57.9%), 220 (32.7%), 34 (22.8%), and 46 (22.7%), respectively. Thirty-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7-5.5 mmol/L: (average risk ratio (RR): 0.72, 95% confidence interval (95% CI): 0.66-0.78); 5.5-6.0 mmol/L: (average RR: 0.60, 95% CI: 0.47-0.73); > 6.0 mmol/L: (average RR: 0.56, 95% CI: 0.46-0.66). Survival did not differ significantly in patients with hypokalemia compared with normokalemia.</p><p><strong>Conclusions: </strong>In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia, independent of age, sex, comorbidity burden and pre-hospital OHCA-characteristics. Conversely, hypokalemia was not associated with reduced 30-day survival.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"144"},"PeriodicalIF":3.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous versus intermittent noninvasive blood pressure measurement in patients with shock in prehospital emergency medicine - a single-center prospective pilot trial.","authors":"Stephan Katzenschlager, Raphael Heck, Nikolai Kaltschmidt, Frank Weilbacher, Markus A Weigand, Erik Popp, Maximilian Dietrich","doi":"10.1186/s13049-025-01457-5","DOIUrl":"https://doi.org/10.1186/s13049-025-01457-5","url":null,"abstract":"<p><strong>Background: </strong>Shock is a critical and potentially life-threatening clinical state characterized by circulatory insufficiency and impaired micro- and macrocirculation. Rapid detection and initiation of therapy are essential for patient outcomes. In prehospital emergency medicine, assessment tools are limited, and intermittent noninvasive blood pressure (iNIBP) monitoring is the current standard of care. Recent findings suggest that this method may miss episodes of relevant hypotension. Continuous noninvasive blood pressure (cNIBP) and tissue oxygenation (StO₂) measurements could improve the time to detection of shock.</p><p><strong>Methods: </strong>This single-center prospective pilot trial compared a cNIBP system with standard iNIBP measurements in physician-staffed prehospital care. The study was conducted in the Rhine-Neckar region between May and December 2023. The Edwards HemoSphere system, including ClearSight for cNIBP and ForeSight for StO₂, was used in conjunction with standard monitoring. Adults with shock were eligible for inclusion. Primary endpoint was the agreement between cNIBP and iNIBP; secondary endpoints included unrecognized hypotension (MAP < 60 mmHg) and comparison between cNIBP/iNIBP and StO₂. Bland-Altman analysis quantified bias and limits of agreement (LoA).</p><p><strong>Results: </strong>In total, 25 patients were included, resulting in 100 simultaneous measurements. iNIBP readings exceeded cNIBP measurements of mean arterial pressure (MAP) by 10.77 mmHg (p < 0.01). There were further significant differences for systolic and diastolic blood pressure, with higher values for iNIBP measurements. Bland-Altman analysis demonstrated systemic bias (MAP bias - 10.25) with wide LoA (-43.52 to 22.21), indicating poor interchangeability. In three out of 25 cases, standard intermittent blood pressure measurements failed to detect hypotension, although cNIBP showed MAP values below 60 mmHg.</p><p><strong>Conclusion: </strong>Our pilot data show cNIBP and iNIBP values differ significantly, with clinical implications, potentially improving hemodynamic instability detection. However, as this is preliminary, more research on system reliability and benefits of enhanced monitoring is needed.</p><p><strong>Trial registration: </strong>German Clinical Trials Registry (DRKS ID DRKS00031867) on 22.05.2023.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"143"},"PeriodicalIF":3.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12369113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triage of road injury casualties - the role of bystanders: a scoping review.","authors":"George Stephen Russam, Jake Gluyas-Harris, Nicholas Aveyard, Tim Nutbeam","doi":"10.1186/s13049-025-01455-7","DOIUrl":"https://doi.org/10.1186/s13049-025-01455-7","url":null,"abstract":"<p><strong>Background: </strong>Bystanders have the potential to be a critical component of the Road Injury Chain of Survival, particularly in the early phases of injury recognition, scene assessment, and emergency service activation. Their potential role in trauma triage remains underexplored. This scoping review aims to examine the existing evidence of the use of bystanders in triage-both laypersons and non-clinical professionals-during the prehospital phase of road injury and other trauma scenarios.</p><p><strong>Methods: </strong>A systematic search was undertaken across MEDLINE, CINAHL, and the Psychology & Behavioural Sciences Collection using the EBSCO Host platform, with supplementary hand searches via Google Scholar and reference screening. Articles were included if they addressed triage by lay or professional bystanders (e.g. police, fire and rescue) in prehospital trauma settings. Data were extracted and synthesised using a descriptive analytical approach.</p><p><strong>Results: </strong>Twenty-three studies were included. Bystanders demonstrated the ability to apply basic triage tools with moderate accuracy, although over-triage was common and under-triage rates often exceeded accepted thresholds. Several trauma training programmes in low-resource settings included triage components, leading to improvements in knowledge and confidence. Long-term retention and real-world clinical utility remain uncertain. Only one study directly evaluated bystander assessment of crash parameters; lay performance approached that of health professionals in some domains. Technological innovations such as video live-streaming from bystanders to emergency call handlers showed potential to enhance triage and situational awareness, though operational and ethical barriers remain.</p><p><strong>Conclusions: </strong>Bystanders may have an expanded role in the triage and early assessment of trauma casualties, particularly in settings where formal EMS is limited or delayed. Within the Road Injury Chain of Survival, empowering bystanders through structured training and technology-enabled support could strengthen early links in the chain. Future research should focus on validating simplified triage approaches, evaluating training impact, and assessing outcomes related to both patient care and system efficiency.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"142"},"PeriodicalIF":3.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12369110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi study.","authors":"Tim Nutbeam, Rob Fenwick, Ian Marritt, Brian Lee, Luke Staveley-Wadham, Nigel Lang, Louise Johnson, Nicolas Mattock, Jane Ogilvie, Emily Foote, Francis Screech, Lara Lebeau-Humarau, Caroline Leech","doi":"10.1186/s13049-025-01451-x","DOIUrl":"10.1186/s13049-025-01451-x","url":null,"abstract":"<p><strong>Background: </strong>Physically trapped patients following motor vehicle collisions are at high risk of time-critical injuries and poor outcomes. Despite this, there is limited consensus on which injuries should be prioritised and which early interventions are both necessary and feasible in the prehospital setting. This study aims to develop expert consensus on injury categorisation and the delivery of early care interventions to guide clinical and operational decision-making at the scene.</p><p><strong>Methods: </strong>A modified Delphi method was used to gather consensus from a multidisciplinary panel of subject matter experts, including clinicians, paramedics, and members of fire and rescue services. In Round 1, participants contributed to the development of draft statements relating to injury time sensitivity, intervention prioritisation, and responder roles. In Rounds 2 and 3, participants rated their level of agreement with these refined statements. A final face-to-face consensus meeting was held to discuss statements that had not yet reached consensus, explore areas of disagreement, and conduct further voting where appropriate. Consensus was defined as ≥ 70% agreement.</p><p><strong>Results: </strong>Consensus was achieved on 45 statements across the domains of injury categorisation, time-critical interventions, and multi-agency responsibilities. Participants strongly endorsed the early delivery of analgesia, tranexamic acid, and protection from environmental stressors, regardless of provider background, provided that appropriate training and governance are in place. There was broad support for expanding the scope of practice of non-clinical responders to meet urgent patient needs.</p><p><strong>Conclusions: </strong>This Delphi consensus provides a framework for prioritising early interventions in the care of trapped patients. It supports a patient-centred, capability-based approach to prehospital care, emphasising feasibility, urgency, and ethical responsibility. Findings should inform the development of standard operating procedures, triage tools, and training frameworks across emergency services, with further research needed to validate assessment heuristics and address barriers to implementation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"141"},"PeriodicalIF":3.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital critical care dispatch: a scoping review (PHASE).","authors":"Peter Owen, Kim Kirby, Julian Hannah, Robert Crouch, Philip Hyde, Sarah Voss","doi":"10.1186/s13049-025-01450-y","DOIUrl":"10.1186/s13049-025-01450-y","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital critical care (PHCC) dispatch is a vital component of emergency medical services, aiming to allocate specialised resources for critically ill or injured patients in out-of-hospital settings. This scoping review examines the existing evidence on optimising PHCC dispatch, identifies research gaps, and highlights priorities for future investigation.</p><p><strong>Methods: </strong>A systematic search of databases including CINAHL, PubMed, EMBASE, and CENTRAL from January 2004 to October 2024. We included all study types, focusing on the dispatch of PHCC assets globally.</p><p><strong>Results: </strong>The search yielded 39 studies that met the inclusion criteria. The included studies varied in design, setting and focus (e.g. Traumatic vs. Medical aetiology). Outcomes measured ranged across dispatch factors, physiological and temporal variables, with advanced intervention and survival metrics commonly used to asses dispatch effectiveness.</p><p><strong>Discussion: </strong>The review found variability in dispatch models, staffing, and outcome measures. Most studies focused on HEMS and P-HEMS, often using injury mechanisms and physiological parameters as dispatch criteria. However, their predictive accuracy is inconsistent, especially for older trauma patients. Clinician involvement improves accuracy, but the role of cognitive tools needs more study. Challenges include ethical and logistical issues in prospective studies, limited research in low- and middle-income countries, and lack of harmonised datasets for missed dispatch opportunities. Technologies like automated crash notifications and real-time video show promise but need more development validation.</p><p><strong>Conclusion: </strong>This review underscores the need for robust, prospective research to refine dispatch criteria and integrate advanced technologies. Addressing these gaps could improve resource allocation, reduce over- and under-triage, and ultimately enhance patient outcomes in PHCC systems.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"140"},"PeriodicalIF":3.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of patients presenting with mental illness in emergency medical services: a retrospective observational study.","authors":"Natalie Bergman, Aleksandra Jarling, Gabriella Boysen Norberg, Beatrice Alenljung, Magnus Hagiwara Andersson","doi":"10.1186/s13049-025-01453-9","DOIUrl":"10.1186/s13049-025-01453-9","url":null,"abstract":"<p><strong>Background: </strong>Mental illness is prevalent worldwide, creating a demand for Emergency Medical Service (EMS) assessments in mental illness, yet research on the epidemiology of patients with mental illness in the EMS is lacking in Sweden. This study aims to describe the patients presenting with symptoms of mental illness in the EMS and how they are assessed in the prehospital setting.</p><p><strong>Method: </strong>A retrospective observational study was conducted to identify patients assessed for symptoms of mental illness in the EMS in 2023. A total of 1,304 records met the inclusion criteria and were included in the study: [1] assessed in the EMS due to symptoms of mental illness and [2] over 13 years old. The data were analysed using IBM SPSS Statistic 28.</p><p><strong>Results: </strong>More females (54.3%) than men (45.7%) were assessed for mental illness (p = < 0.01). The median age was 39 years, with an interquartile range (IQR) of 32 years (p = < 0.01) and a total range of 13-91. Most patients were assessed once, with a range of 1 to 37 times. The initial priority of the patients was mainly Priority 1 (45.6%) or Priority 2 (49.9%). However, this shifted after the EMS assessment where most patients either recieved a lower priority or No priority [due to not being transported] (39.7%). The most common triage colour was Orange (21.4%), indicating the need for acute care, but four out of ten patients did not recieve a triage color (40.4%). The most frequent patients assessed by the EMS were suicide threats/attempts (45.2%) and intoxications (48.8%) with intoxication cases most likely to be hospitalised. The length of the stay in the hospital varied from 0 to 67 days but most patients were discharged within 24 h (6.8%) or admitted for 24 h (6.4%).</p><p><strong>Conclusion: </strong>Patients with mental illness are frequently assessed in the EMS, primarily for suicide threats/attempts and intoxication. However, few are admitted to the hospital, and many are not triaged, suggesting difficulties in referring patients with mental illness to the right level of care. The result may inform future studies assessing patients with mental illness in the EMS.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"139"},"PeriodicalIF":3.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endotracheal intubation during cardiac arrest by critical care paramedics: a service evaluation of success rates following structured education.","authors":"Thomas Appelboam, Simon Laing, Nigel Lang","doi":"10.1186/s13049-025-01444-w","DOIUrl":"10.1186/s13049-025-01444-w","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal intubation is an important pre-hospital intervention in critically ill patients. However, it can be a challenging skill, and previous studies have highlighted varying success rates. The European Resuscitation Council (ERC) have set a clear target of a greater than 95% success rate within two attempts, for all clinicians who provide endotracheal intubation during cardiac arrest. This service evaluation looks to explore the impact of training and education on the intubation performance of critical care paramedics.</p><p><strong>Methods: </strong>Retrospective data was collected from a single service over a six year period, from April 2019 to December 2024. During that time period, a number of educational or organisational interventions were introduced, with the aim of improving endotracheal intubation success rates. Data from all intubation attempts for patients in cardiac arrest by critical-care paramedics working with the Devon Air Ambulance Trust were recorded. The primary outcome was the rate of success of endotracheal intubation within two attempts. Secondary outcomes included the rate of first-pass success and the number of patients who had a failed first intubation attempt and did not receive a subsequent attempt. A Chi-squared statistical test was used to judge the significance of change between data from the years 2019 and 2024.</p><p><strong>Results: </strong>390 patients were included and reviewed. Between 2019 and 2024, success rates within two attempts improved by 7.9% points (χ² = 4.205, p = 0.040), while first-pass success rates improved by 18.4% points (χ² = 7.125, p = 0.0076). The success rate within two attempts at endotracheal intubation in 2024 was 97.7%. Over the whole time period, intubation was successful within two attempts in 94.6% (n = 369) of patients, while the first-pass success rate was 82.6% (n = 322). Of the 68 patients who had an unsuccessful first intubation attempt, 19.1% (n = 13) did not receive a second attempt.</p><p><strong>Conclusions: </strong>Implementation of a training and education programme was associated with a significant improvement in endotracheal intubation success rates within the service. With dedicated training, critical care paramedics demonstrate safe and effective endotracheal intubation for patients in out-of-hospital cardiac arrest, meeting the ERC recommendations of a greater than 95% success rate within two attempts at intubation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"138"},"PeriodicalIF":3.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing blood wastage through introduction of a transfusion team.","authors":"Biswadev Mitra, Ruby Garland, Jackson Catalano, Gerard O'Reilly, Alexandra Nevill","doi":"10.1186/s13049-025-01452-w","DOIUrl":"10.1186/s13049-025-01452-w","url":null,"abstract":"<p><strong>Background: </strong>In the intense setting of reception and resuscitation of critically bleeding patients, wastage of up to 10% of blood components occur, commonly due to prolonged breaks in the cold chain. Additionally, some transfusions may be avoidable. The aim of this study was to assess the impact of dedicated transfusion teams (staff focused solely on blood handling during resuscitation) on blood component wastage and transfusion volumes.</p><p><strong>Methods: </strong>This was a retrospective pre- and post-intervention study. We introduced a transfusion team for all episodes of blood transfusion in a level 1 trauma centre. The core elements of the intervention were: (1) dedicated 'blood checkers' without other competing duties during the resuscitation, (2) a 17-minute timer activated on receipt of blood components, (3) telephone for communication with the blood bank, and (4) a pre-determined process of blood component request, usage and return discussed at the initial team huddle.</p><p><strong>Results: </strong>Patient demographics, indications for transfusion and massive transfusion rates were similar between the pre- and post-intervention periods. During 01 Jan 2019 to 30 Jun 2021 (pre-intervention), 109 (1.7%) of 6619 blood component units dispensed were wasted. Following the intervention, until 30 Jun 2023, 73 (1.1%) of 6575 units were wasted (p = 0.008). In the post intervention period, median patient transfusion volumes were significantly lower at 2 (inter-quartile range; IQR 2-6) compared to 3 (IQR 2-6) units (p = 0.002).</p><p><strong>Discussion: </strong>Dedicated transfusion teams during emergency use of blood were associated with lower wastage and lower transfusion volumes. Transfusion teams may lead to more precise management of critical bleeding, while enabling cognitive capacity for the team leader to focus on identifying and controlling haemorrhage.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"136"},"PeriodicalIF":3.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising the care of the trapped patient following a motor vehicle collision: A UK-Based Delphi consensus study.","authors":"Tim Nutbeam, Rob Fenwick, Ian Marritt, Brian Lee, Luke Staveley-Wadham, Nigel Lang, Louise Johnson, Nicolas Mattock, Jane Ogilvie, Emily Foote, Francis Screech, Lara Lebeau-Humarau, Caroline Leech","doi":"10.1186/s13049-025-01449-5","DOIUrl":"10.1186/s13049-025-01449-5","url":null,"abstract":"<p><strong>Background: </strong>Motor vehicle collisions (MVCs) are a leading cause of injury and death worldwide. Up to 40% of casualties may become trapped and entrapment is associated with delayed care and worse outcomes. There is little national or international consensus guiding the care of physically trapped patients who cannot self-extricate. This study aimed to develop multidisciplinary consensus-based principles to optimise clinical and operational care for trapped patients following MVC.</p><p><strong>Methods: </strong>A three-round Delphi study was conducted from January to March 2025, following the CREDES framework. A multi-professional steering group developed preliminary statements informed by literature review and expert consultation. Subject matter experts (SMEs) with operational experience in extrication, prehospital, and trauma care were recruited through stakeholder organisations. Statements were refined iteratively through SME feedback. Consensus was defined as ≥ 70% agreement or disagreement. Statements reaching consensus were removed from subsequent rounds; others were revised based on free-text feedback.</p><p><strong>Results: </strong>Sixty-six SMEs participated, with high engagement across all three rounds. Consensus was achieved for 104 statements covering standardised extrication terminology, prioritisation of time-sensitive extrication for critically injured patients, minimisation of unnecessary on-scene interventions, emphasis on early psychological support for trapped casualties, and the importance of interdisciplinary communication and coordination. The consensus supports a paradigm shift towards rapid, patient-centred extrication, balancing clinical needs, operational realities, and psychological welfare.</p><p><strong>Conclusions: </strong>This Delphi study establishes expert-endorsed principles for the care of physically trapped patients following MVCs. Adoption of these principles could reduce delays, strengthen multi-agency response and improve patient outcomes. Further work is required to validate the impact of these recommendations on clinical outcomes and to support their integration into practice through policy development, training, and evaluation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"137"},"PeriodicalIF":3.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate post-ECPR management strategies in the prehospital and critical care transport medicine environments.","authors":"Ella Purington, Christopher R Shaw, Erica Berglund, Bronwyn Finney, Jeffrey Dellavolpe, Mark Dennis, Dinis Reis Miranda, Alice Hutin, Andrea M Elliott, Jason A Bartos, Cindy H Hsu, Brittney Bernardoni, Michael J Lauria, Adam L Gottula","doi":"10.1186/s13049-025-01448-6","DOIUrl":"10.1186/s13049-025-01448-6","url":null,"abstract":"<p><p>Despite advancements in care, out-of-hospital cardiac arrest has a low survival rate. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown improved outcomes in select cases, notably in the ARREST trial. However, ECPR is resource-intensive and limited to specialized centers, restricting access in many regions. Estimates suggest only 2-10% of out-of-hospital cardiac arrest patients are ECPR candidates. Advanced systems initiating ECPR in prehospital environments or non-ECMO-capable centers have shown promise. As ECPR utilization increases, so does the need for transport to ECMO-capable centers. Unlike conventional out-of-hospital cardiac arrest care, high-quality evidence for post-resuscitation management of ECPR patients is lacking. This review provides suggestions for the immediate post-resuscitation management (4-6 h) of ECPR patients in prehospital settings, the critical care transport medicine environment, and at non-ECMO-capable centers. Goals include treating the precipitating cause of cardiac arrest, maintaining end-organ perfusion, optimizing oxygen delivery, promoting myocardial recovery, and preventing complications associated with V-A ECMO. Continued research is needed to establish evidence-based protocols that ensure the safe and effective management of ECPR patients.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"135"},"PeriodicalIF":3.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}