Critical Care

Trauma and coagulopathy are the focus of Iain and Simon's October 2020 round-up. The episode notes link to appraisals of prehospital TXA, plasma in traumatic brain injury, targeted transfusion testing and other clinical topics, alongside a conversation about coping with the second pandemic wave.

Could early prehospital plasma help trauma patients with brain injury? This 2020 review examines a secondary analysis of PAMPer, its apparent survival signal and why post-hoc findings, uncertain mechanisms and unanswered neurological-outcome questions require caution before changing practice.

Could carotid ultrasound make pulse checks more reliable? Natalie May examines a proof-of-concept study using recordings from patients undergoing cardiac surgery, and explains why interpreting those images is a different challenge from obtaining and using them during a real cardiac arrest.

What does STAAMP add to the evidence for prehospital tranexamic acid after trauma? This 2020 appraisal examines the lack of a clear overall mortality benefit, recruitment and power limitations, safety findings and the caution needed when interpreting encouraging timing, shock and dosing subgroups.

Can TEG or ROTEM improve outcomes when added to major haemorrhage care? Natalie May reviews the iTACTIC trial's comparison with conventional coagulation testing, separating faster treatment decisions from demonstrated patient benefit and examining the limits of its size and subgroup findings.

Dan Horner revisits the evidence on venous thromboembolism in COVID-19 as it stood in October 2020. The review examines how screening and case selection affect reported clot rates, the distinction between different thrombotic findings, and uncertainty around risk prediction and higher-dose anticoagulation.