Evidence map›Paper›PMID 40457450›Full record

SynthesisWorld journal of emergency surgery : WJES2025

Prioritizing circulation over airway to improve survival in trauma patients with exsanguinating injuries: a world society of emergency surgery-panamerican trauma consensus statement.

Paula Ferrada, Saima Shafique, Megan Brenner, Clay Burlew, Fausto Catena, Julia Coleman, Jamie Coleman, Demetrios Demetriades, Marc Demoya, Salomone Di Saverio and 53 more

Abstract readSystematic ReviewMeta-AnalysisConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in World journal of emergency surgery : WJES, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

63 authors.

Paula FerradaInova Healthcare System, 3300 Gallows Road, Falls Church, VA, USA. paula.ferrada@inova.org.
Saima ShafiqueInova Healthcare System, 3300 Gallows Road, Falls Church, VA, USA.
Megan BrennerDavid Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
Clay BurlewUniversity of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Fausto CatenaUniversity of Bologna, Bufalini Hospital, Cesena, Italy.
Julia ColemanThe Ohio State University, Columbus, OH, USA.
Jamie ColemanUniversity of Louisville School of Medicine, Louisville, KY, USA.
Demetrios DemetriadesDepartment of Surgery, Los Angeles County + USC Medical Center, Los Angeles, CA, USA.
Marc DemoyaMedical College of Wisconsin, Froedtert Trauma Center, Milwaukee, WI, USA.
Salomone Di SaverioAST Ascoli Piceno, Madonna del Soccorso Hospital, Ascoli Piceno, Italy.
Sharmila DissanaikeUniversity of New Mexico, Albuquerque, NM, USA.
Tom DransfieldNew Orleans EMS, New Orleans, LA, USA.
Joseph DuBoseDell Medical School, University of Texas - Austin, Austin, TX, USA.
Juan DuchesneTulane University School of Medicine, New Orleans, LA, USA.
Adel ElkbuliOrlando Regional Medical Center, Orlando, FL, USA.
Esteban FoianiniClinica Foianini, Santa Cruz, Bolivia.
Josephine GambardellaInova Healthcare System, 3300 Gallows Road, Falls Church, VA, USA.
Alberto GarciaDepartment of Surgery, Fundacion Valle Del Lili University Hospital, Universidad Icesi, Cali, Colombia.
Amy GoldbergTemple University Hospital, Philadelphia, PA, USA.
Eric GoralnickDepartment of Emergency Medicine Mass General Brigham, Harvard Medical School, Boston, MA, USA.
John HolcombUniversity of Alabama at Birmingham, Birmingham, AL, USA.
Messing JonathanInova Healthcare System, 3300 Gallows Road, Falls Church, VA, USA.
Bellal JosephDivision of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
Lenworth JacobsUniversity of Connecticut, Farmington, CT, USA.
Jeffrey KerbyUniversity of Alabama at Birmingham, Birmingham, AL, USA.
Robert LawerancePro EMS, Cambridge, MA, USA.
Stefan LeichtleInova Healthcare System, 3300 Gallows Road, Falls Church, VA, USA.
Charles LucasWayne State University - Detroit Receiving Hospital, Detroit, MI, USA.
Gustavo MachainUniversidad Nacional de Caaguazu - Facultad de Ciencias Médicas, Coronel Oviedo, Paraguay.
Jana MacleodKenyatta University, Nairobi, Kenya.
Zoe MaherTemple University Hospital, Philadelphia, PA, USA.
Matthew MartinDepartment of Surgery, Los Angeles County + USC Medical Center, Los Angeles, CA, USA.
Napoleon MendezUniversidad de San Carlos, Ciudad de Guatemala, Guatemala.
Carlos MenegozzoFaculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
Ilenia MerliniAST Ascoli Piceno, Madonna del Soccorso Hospital, Ascoli Piceno, Italy.
Nicholas NamiasUniversity of Miami, Miami, FL, USA.
Mayur NarayanRutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Carlos OrdonezDepartment of Surgery, Fundacion Valle Del Lili University Hospital, Universidad Icesi, Cali, Colombia.
Pablo OttolinoHospital Sótero del Río, Santiago, Chile.
Mayur PatelVanderbilt University Medical Center, Nashville, TN, USA.
Zaffer A QasimUniversity of Pennsylvania Health System, Philadelphia, PA, USA.
Martha QuiodettisHospital Santo Tomas, Ciudad de Panama, Panama.
LeAnne Sitari YoungTexas Children's Hospital, Houston, TX, USA.
Ashanti RatnasekeraDrexel College of Medicine, ChristianaCare, Newark, DE, USA.
David RayburnNew Orleans EMS, New Orleans, LA, USA.
Juan SalameaUniversidad del Azuay, Cuenca, Ecuador.
Babak SaraniDepartment of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Thomas ScaleaUniversity of Maryland, Shock Trauma Center, Baltimore, MD, USA.
Mark SeamonUniversity of Pennsylvania, Philadelphia, PA, USA.
David SpainDepartment of Surgery, Stanford University, Stanford, CA, USA.
Portia SteeleInova Healthcare System, 3300 Gallows Road, Falls Church, VA, USA.
Sharven TaghaviTulane University School of Medicine, New Orleans, LA, USA.
Leah TatebeNorthwestern University, Chicago, IL, USA.
Felipe VegaHospital Angeles Lomas, Ciudad de Mexico, Mexico.
George VelmahosMassachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Tanya ZakrisonUniversity of Chicago Medicine, Chicago, IL, USA.
Walter L BifflScripps Clinic/Scripps Clinic Medical Group, San Diego, CA, USA.
Dimitrios DamaskosRoyal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
Federico CoccoliniGeneral, Emergency and Trauma Surgery Dept, Pisa University Hospital, Pisa, Italy.
Carlo VallicelliGeneral, Emergency and Trauma Surgery Department, Maurizio Bufalini Hospital, Cesena, Italy.
Ernest E MooreErnest E. Moore Shock Trauma Center, University of Colorado Denver, Denver, CO, USA.
Luca AnsaloniUnit of General Surgery I, Ospedali Riuniti of Bergamo, Bergamo, Italy.
Yoram KlugerLanido Medical Center, Natanya, Israel.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionHemorrhage is one of the leading causes of preventable death in trauma patients. For decades, the Airway-Breathing-Circulation (ABC) approach has been the cornerstone of trauma care. However, emerging evidence suggests that prioritizing airway management in exsanguinating patients may worsen hypotension and increase mortality. This systematic review and meta-analysis aim to evaluate the effectiveness of the Circulation-Airway-Breathing (CAB) approach compared to the traditional ABC sequence in improving survival in trauma patients with severe hemorrhage.

methodsA systematic review was conducted in accordance with the PRISMA guidelines. Databases including PubMed and Ovid MEDLINE, SCOPUS, web of science and EMBASE were searched for studies published up to September 2024. Eligible studies included observational and comparative studies reporting outcomes of trauma patients with exsanguinating hemorrhage. The Newcastle-Ottawa Scale was used for risk of bias assessment. A meta-analysis was performed using a random-effects model to calculate pooled odds ratios (OR) for mortality, with 95% confidence intervals (CI). Subgroup analysis was conducted to compare the ABC and CAB approaches in prospective and retrospective studies.

resultsSix studies (N = 11,855 patients) met the inclusion criteria. The meta-analysis revealed a significant increase in mortality associated with the ABC approach (pooled OR: 3.65, 95% CI: 1.74-7.65). Subgroup analysis of prospective cohort studies found an even higher mortality risk (POR: 9.99, 95% CI: 5.59-17.85) when compared with POR of retrospective studies (POR: 2.42, 95%CI: 1.08-5.36). High heterogeneity (I2 = 92%) was observed across the studies, likely due to variations in patient populations and resuscitation protocols.

conclusionPrioritizing circulation over airway management in trauma patients with exsanguinating injuries significantly reduces mortality compared to the traditional ABC approach. The present consensus paper, conducted according to the WSES methodology

Indexed as

Airway ManagementExsanguinationWounds and InjuriesConsensusHumans

Identifiers

PMID40457450
PMCPMC12128548

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.