Prehospital Management of Hypotensive Trauma in HEMS

NCT ID: NCT04760977

Last Updated: 2024-08-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

500 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-05-01

Study Completion Date

2026-05-01

Brief Summary

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Up to today, inadequate evidences and knowledge exist about the best prehospital management of hypotensive trauma patients and its clinical consequence on the in-hospital recovery and mortality.

Also new emerging therapies such as prehospital blood transfusion and REBOA (resuscitative endovascular balloon occlusion of the aorta) are lacking strong evidences in, eventually, reducing hospital mortality and improving outcomes.

Moreover, prehospital emergency medicine is throughout Italy an heterogeneous system that has no unique standard operating procedures and, even among HEMS (helicopter emergency medical service), management and therapies on complex trauma patients may vary upon local policies.

With this study we aim to enroll hypotensive trauma patients and study factors of prehospital rescue that can be associated with in-hospital mortality and recovery, eventually even with hospital outcome. For each patients data as demographic, kind of trauma (mechanism, injury scores), therapies and maneuvers will be recorded and then analyzed in comparison with in-hospital data such as need for transfusion, ABG parameters, length of stay (in-ward and ICU), need of therapies like invasive ventilation and renal replacement therapy, recovery and outcome

Detailed Description

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Conditions

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Hypotension and Shock Wounds and Injuries Emergencies Critical Care

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Trauma patients in shock

The study focuses on hypotensive trauma patients assisted by HEMS teams

Drugs administration

Intervention Type DRUG

Antifibrinolytics, analgesics, sedatives, neuromuscular blocking agents

Resuscitative endovascular balloon occlusion of the aorta

Intervention Type DEVICE

Resuscitative technique for exsanguinating traumas

Blood transfusions

Intervention Type BIOLOGICAL

Transfuion of transported blood products for exsanguinating traumas

Prehospital management

Intervention Type OTHER

Stay and play strategy vs scoop and run

Prehospital eFAST

Intervention Type DEVICE

Prehospital thorax/abdomen extended focused assessment sonography for trauma

Interventions

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Drugs administration

Antifibrinolytics, analgesics, sedatives, neuromuscular blocking agents

Intervention Type DRUG

Resuscitative endovascular balloon occlusion of the aorta

Resuscitative technique for exsanguinating traumas

Intervention Type DEVICE

Blood transfusions

Transfuion of transported blood products for exsanguinating traumas

Intervention Type BIOLOGICAL

Prehospital management

Stay and play strategy vs scoop and run

Intervention Type OTHER

Prehospital eFAST

Prehospital thorax/abdomen extended focused assessment sonography for trauma

Intervention Type DEVICE

Other Intervention Names

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REBOA

Eligibility Criteria

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Inclusion Criteria

* Age \> 18 years
* Witnessed traumatic event managed by HEMS
* Shock at first evaluation (Systolic blood pressure \< 90 mmHg)
* Suspect or obvious ongoing haemorrage

Exclusion Criteria

* Patients in cardiac arrest at HEMS arrival in which resuscitation is not started or interrupted by HEMS crew
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Azienda Usl di Bologna

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Ospedale di Alessandria

Alessandria, , Italy

Site Status RECRUITING

Base HEMS Aosta

Aosta, , Italy

Site Status NOT_YET_RECRUITING

Ospedale di Bolzano

Bologna, , Italy

Site Status NOT_YET_RECRUITING

Base HEMS Borgo Sesia

Borgosesia, , Italy

Site Status NOT_YET_RECRUITING

Base HEMS Cuneo-Levaldigi

Cuneo, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Careggi Firenze

Florence, , Italy

Site Status NOT_YET_RECRUITING

Ospedale di Siena, Ospedale di Pisa

Grosseto, , Italy

Site Status RECRUITING

Ospedale di Siena, Ospedale di Pisa

Massa, , Italy

Site Status NOT_YET_RECRUITING

Ospedale di Padova

Padua, , Italy

Site Status NOT_YET_RECRUITING

Pavullo HEMS base

Pavullo nel Frignano, , Italy

Site Status NOT_YET_RECRUITING

Pieve di Cadore HEMS base

Pieve di Cadore, , Italy

Site Status NOT_YET_RECRUITING

Ospedale di Torino

Torino, , Italy

Site Status NOT_YET_RECRUITING

Base HEMS Trento

Trento, , Italy

Site Status NOT_YET_RECRUITING

Treviso hospital

Treviso, , Italy

Site Status NOT_YET_RECRUITING

Udine FVG

Udine, , Italy

Site Status NOT_YET_RECRUITING

Ospedale di Verona Borgo Trento

Verona, , Italy

Site Status NOT_YET_RECRUITING

Countries

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Italy

Central Contacts

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Marco Tartaglione, MD

Role: CONTACT

+390516368215

Lorenzo Gamberini, MD

Role: CONTACT

Facility Contacts

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Andrea Mina

Role: primary

Simona Cavallo

Role: backup

Andrea Caglià

Role: primary

Francesca Verginella

Role: primary

Andrea Mina

Role: primary

Simona Cavallo

Role: backup

Andrea Mina

Role: primary

Simona Cavallo

Role: backup

Mario Rugna

Role: primary

Giovanni Sbrana

Role: primary

Silvia Pini

Role: primary

Andrea Vignali

Role: backup

Andrea Paoli

Role: primary

Giulio Desiderio, MD

Role: primary

Cristina Barbarino, MD

Role: primary

Andrea Mina

Role: primary

Simona Cavallo

Role: backup

Vittorio Albarello

Role: primary

Giovanna Zilio, MD

Role: primary

Davide Durì, MD

Role: primary

Giacomo Magagnotti

Role: primary

References

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Brown JB, Sperry JL, Fombona A, Billiar TR, Peitzman AB, Guyette FX. Pre-trauma center red blood cell transfusion is associated with improved early outcomes in air medical trauma patients. J Am Coll Surg. 2015 May;220(5):797-808. doi: 10.1016/j.jamcollsurg.2015.01.006. Epub 2015 Jan 24.

Reference Type BACKGROUND
PMID: 25840537 (View on PubMed)

Smith IM, James RH, Dretzke J, Midwinter MJ. Prehospital Blood Product Resuscitation for Trauma: A Systematic Review. Shock. 2016 Jul;46(1):3-16. doi: 10.1097/SHK.0000000000000569.

Reference Type RESULT
PMID: 26825635 (View on PubMed)

Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019 Mar 27;23(1):98. doi: 10.1186/s13054-019-2347-3.

Reference Type RESULT
PMID: 30917843 (View on PubMed)

Powell EK, Hinckley WR, Gottula A, Hart KW, Lindsell CJ, McMullan JT. Shorter times to packed red blood cell transfusion are associated with decreased risk of death in traumatically injured patients. J Trauma Acute Care Surg. 2016 Sep;81(3):458-62. doi: 10.1097/TA.0000000000001078.

Reference Type RESULT
PMID: 27050884 (View on PubMed)

Brohi K, Gruen RL, Holcomb JB. Why are bleeding trauma patients still dying? Intensive Care Med. 2019 May;45(5):709-711. doi: 10.1007/s00134-019-05560-x. Epub 2019 Feb 11. No abstract available.

Reference Type RESULT
PMID: 30741331 (View on PubMed)

Tartaglione M, Carenzo L, Gamberini L, Lupi C, Giugni A, Mazzoli CA, Chiarini V, Cavagna S, Allegri D, Holcomb JB, Lockey D, Sbrana G, Gordini G, Coniglio C; SPITFIRE Study Collaborators. Multicentre observational study on practice of prehospital management of hypotensive trauma patients: the SPITFIRE study protocol. BMJ Open. 2022 May 30;12(5):e062097. doi: 10.1136/bmjopen-2022-062097.

Reference Type DERIVED
PMID: 35636792 (View on PubMed)

Other Identifiers

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959-2020-OSS-AUSLBO

Identifier Type: -

Identifier Source: org_study_id

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