Prioritizing circulation over airway in trauma patients with exsanguinating injuries: What you need to know.

Abstract

Hemorrhage remains a leading cause of preventable trauma-related mortality, with early resuscitation and hemorrhage control serving as crucial interventions. Emerging evidence suggests that prioritizing circulation before airway (Circulation, Airway, and Breathing [CAB]) during initial resuscitation in patients with exsanguinating injuries can improve survival by avoiding the deleterious effects of postintubation hypotension. This article reviews current evidence supporting the CAB approach and outlines best practices across prehospital, emergency department, and operative settings. Delaying advanced airway management while focusing on immediate hemorrhage control and blood product resuscitation has been associated with decreased 24-hour and 30-day mortality. This review synthesizes findings from recent multicenter trials and literature supporting the CAB paradigm, with practical recommendations for implementation in trauma care systems.