Evidence map›Paper›PMID 40947837›Full record

Observational studyAnaesthesia2026

An observational study of pre-hospital central venous access for patients with haemorrhagic shock due to major trauma.

Paolo Pallavicini, Luca Carenzo, Ryan Adams, Flora Bird, Ross Davenport, Robert Greenhalgh, Andrew E Wood, Jack Gallagher, Sara Williams, Daryl Newland and 4 more

Abstract readObservational Study
In one paragraph

Observational study in Anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing 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

3 citing papers in PubMed.

  1. Article
  2. Article
  3. The impact of advanced pre-hospital interventions on scene time.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026
    Observational
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

14 authors.

Paolo PallaviciniCentre for Trauma Sciences, Queen Mary University of London, London, United Kingdom.
Luca CarenzoDepartment of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy.
Ryan AdamsCentre for Trauma Sciences, Queen Mary University of London, London, United Kingdom.
Flora BirdLondon's Air Ambulance, London, UK.
Ross DavenportCentre for Trauma Sciences, Queen Mary University of London, London, United Kingdom.
Robert GreenhalghLondon's Air Ambulance, London, UK.
Andrew E WoodLondon's Air Ambulance, London, UK.
Jack GallagherAnaesthetic Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Sara WilliamsEmergency Department, St George's University Hospital NHS Foundation Trust, London, UK.
Daryl NewlandMajor Trauma Care Group, King's College Hospital, London, UK.
David J LockeyCentre for Trauma Sciences, Queen Mary University of London, London, United Kingdom.
Zane B PerkinsCentre for Trauma Sciences, Queen Mary University of London, London, United Kingdom.
Ewoud Ter AvestLondon's Air Ambulance, London, UK.ORCID 0000-0002-1462-6130
Exsanguination Working Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionExsanguinating haemorrhagic shock due to major trauma is associated with high mortality. Rapid intravenous volume replacement with blood products is a crucial element of early treatment. When peripheral intravenous access cannot be obtained, pre-hospital placement of a large-calibre central venous catheter, known as a trauma line, can be a life-saving alternative.

methodsThis was a retrospective cohort study to evaluate the feasibility, efficacy and safety profile of inserting a 14-Fr trauma line in patients with exsanguinating haemorrhage due to major trauma in the pre-hospital setting. Success rates, outcomes and complications of trauma line insertion were determined by cross-referencing pre-hospital patient care records with emergency department notes, operating notes and post-mortem findings.

resultsBetween 1 January 2019 and 31 July 2023, London's Air Ambulance attended 8104 patients. Trauma line insertion was attempted in 346 (4%) patients with success in 276 (80%). Successful trauma line insertion was associated with significantly greater transfusion of pre-hospital blood products compared with those in whom insertion was unsuccessful (median (IQR [range]) 4 (2-6 [0-12]) vs. 2 (0-4 [0-8]) units, respectively; p < 0.001). Survival to presentation to the emergency department was higher after successful trauma line insertion (149/279 (54%) vs. 25/70 (36%); p = 0.006). There were 184 (53%) patients transported to hospital. Complications in this group were reported in 8 (4%) patients: malpositioned trauma line (n = 3); vascular injuries (n = 2); iatrogenic pneumothorax (n = 2); and positive trauma line tip culture (n = 1). DISCUSSION: In patients with exsanguinating haemorrhage who are in severe shock or traumatic cardiac arrest, pre-hospital trauma line insertion is feasible and associated with an acceptable risk of procedural complications. Trauma lines enable the delivery of a greater volume of blood products in the pre-hospital setting, which may be associated with increased pre-hospital survival.

Indexed as

Catheterization, Central VenousEmergency Medical ServicesShock, HemorrhagicWounds and InjuriesAdultAgedBlood TransfusionCohort StudiesFeasibility StudiesFemaleHumansMaleMiddle AgedRetrospective Studiescentral venous cathetercritical carehaemorrhagemajor traumapre‐hospital

Identifiers

PMID40947837
PMCPMC12747594

What Socratic holds

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LicenceCC BY-NC
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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.