This collection of trauma trials and guidelines should serve as a sort of suggested reading material for the CICM Second Part exam candidate preparing for the increasingly unpredictable Fellowship exam, to supplement the increasingly inadequate practice of revising by doing past papers. Trauma overlaps considerably with transfusion medicine for obvious reasons, and so some of the trials and guidelines here may be duplicates of those found in the corresponding haematology section. Most of these have come from Critical Care Reviews and The Bottom Line. Wherever possible, the original paper is linked from the name of the study, and the Bottom Line review is linked from the year of publication.
COMBAT - 2018 - prehospital FFP again, n=125 in the US. No difference in mortality (15% vs 10%)
ITACTIC - 2020 - TEG/ROTEM vs. coags in trauma. Less product use? n=392 in Europe. No difference in product use; but also hardly any product use (only 67% and 36% of the groups got any blood products).
PREHO-PLYO - 2022 - why not prehospital lyophilised plasma? n=150 in France. No difference in the need for massive transfusion (10.3% vs 6.1%).
RESTRIC - 2023 - what if Hb 70-90 for severe trauma, instead 100-120? n=411 in Japan. No difference in survival (92.1% vs 91.3%)
CRASH-2 - 2010 - what if we give TXA to trauma patients? n=20,207 all over the world. Improved mortality (14.5% vs 16%), but they weren't very bleedy (only 5% of patients actually died of haemorrhage)
CRASH-3 - 2019 - what if TXA, but in TBI? n=12737, all over the world. No mortality difference (18.5% vs 19.8%), no difference in DVT/PE (1.6% vs 1.6%). Signal for better mortality in mild-moderate TBI (5.8% vs 7.5%).
PATCH-Trauma - 2023 - what if TXA, but prehospital? n=1310, in Australia NZ and Germany. Significantly reduced mortality at 24 hrs and 28 days but there was no difference in good-functioning survival at 6 months (53.7% vs 53.5%).
HYPOLYTE - 2010 - why not some steroids? n=149 in France. Decreased risk of VAP (35.6% vs 51.3%) but increased duration of ventilation by six days.
Head and facial injury guidelines
Neck and spinal injury guidelines
Chest injury guidelines
Abdominal and pelvic injury guidelines
Trauma resuscitation guidelines
VTE prophylaxis in trauma