{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:22:10Z","timestamp":1792135330724,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Exsanguinating 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\u2010hospital placement of a large\u2010calibre central venous catheter, known as a trauma line, can be a life\u2010saving alternative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective cohort study to evaluate the feasibility, efficacy and safety profile of inserting a 14\u2010Fr trauma line in patients with exsanguinating haemorrhage due to major trauma in the pre\u2010hospital setting. Success rates, outcomes and complications of trauma line insertion were determined by cross\u2010referencing pre\u2010hospital patient care records with emergency department notes, operating notes and post\u2010mortem findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 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\u2010hospital blood products compared with those in whom insertion was unsuccessful (median (IQR [range]) 4 (2\u20136 [0\u201312]) vs. 2 (0\u20134 [0\u20138]) units, respectively; p\u2009&lt;\u20090.001). Survival to presentation to the emergency department was higher after successful trauma line insertion (149\/279 (54%) vs. 25\/70 (36%); p\u2009=\u20090.006). There were 184 (53%) patients transported to hospital. Complications in this group were reported in 8 (4%) patients: malpositioned trauma line (n\u2009=\u20093); vascular injuries (n\u2009=\u20092); iatrogenic pneumothorax (n\u2009=\u20092); and positive trauma line tip culture (n\u2009=\u20091).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In patients with exsanguinating haemorrhage who are in severe shock or traumatic cardiac arrest, pre\u2010hospital 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\u2010hospital setting, which may be associated with increased pre\u2010hospital survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.16778","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T06:49:49Z","timestamp":1757918989000},"page":"83-91","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["An observational study of pre\u2010hospital central venous access for patients with haemorrhagic shock due to major trauma"],"prefix":"10.1111","volume":"81","author":[{"given":"Paolo","family":"Pallavicini","sequence":"first","affiliation":[{"name":"Centre for Trauma Sciences Queen Mary University of London  London United Kingdom"},{"name":"Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Carenzo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine IRCCS Humanitas Research Hospital, Rozzano  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Adams","sequence":"additional","affiliation":[{"name":"Centre for Trauma Sciences Queen Mary University of London  London United Kingdom"},{"name":"Major Trauma Service Bart's Health NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flora","family":"Bird","sequence":"additional","affiliation":[{"name":"London's Air Ambulance  London UK"},{"name":"Emergency Department Barts Health NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Davenport","sequence":"additional","affiliation":[{"name":"Centre for Trauma Sciences Queen Mary University of London  London United 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George's University Hospital NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daryl","family":"Newland","sequence":"additional","affiliation":[{"name":"Major Trauma Care Group King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Lockey","sequence":"additional","affiliation":[{"name":"Centre for Trauma Sciences Queen Mary University of London  London United Kingdom"},{"name":"London's Air Ambulance  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zane B.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Centre for Trauma Sciences Queen Mary University of London  London United Kingdom"},{"name":"London's Air Ambulance  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1462-6130","authenticated-orcid":false,"given":"Ewoud","family":"ter Avest","sequence":"additional","affiliation":[{"name":"London's Air Ambulance  London UK"},{"name":"University Medical Centre Groningen, University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Exsanguination Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1705649"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2015.3104"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068\u2010023\u201002367\u2010w"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010022\u201004052\u20107"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2024.3097"},{"key":"e_1_2_6_7_1","volume-title":"PHTLS: Pre\u2010hospital Trauma Life 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