Background
Non-compressible truncal haemorrhage is a subset of major trauma with significant mortality. Since 2021 a new protocol implemented in our “Code Crimson” (CC) major trauma where unstable patients are systematically taken to the hybrid theatre to perform EndoVascular-FIrst Resuscitative Stabilisation in Trauma (Ev-FIRST) as bridge to definitive surgical management. Our study aims to assess the use of Ev-FIRST in major trauma at our quaternary trauma centre from 2021.
Methods
Patients with major trauma who were brought into the Emergency Department, Code Crimson was activated, and there was direct transfer to the hybrid operating theatre were included. An analysis of patients who presented with major trauma prior to, and after introduction of Ev-FIRST as part of the trauma protocol at our institution between the years 2018-2024. The primary endpoints measured include haemorrhage and haemodynamic control, definitive surgical intervention, and survival.
Results
Between 2018 to 2019 there were 18 CC activations with a total mortality of 28%. Between 2021-2024 there were 53 CC activations with total mortality of 32%. Ev-FIRST was implemented in 13 severe cases with 5 mortalities (38%) including neuro-trauma. In each of the cases use of Ev-FIRST allowed temporary resolution of hypotension for definitive surgical intervention or diagnostic imaging.
Conclusion
Ev-FIRST is a valuable lifesaving technique, allowing for haemorrhage control and augmentation of blood pressure as a bridge to definitive management in major trauma. Four year data at this institution demonstrates it should be part of the initial resuscitation process in all trauma centers with a hybrid theatre, appropriate equipment, and trained staff.