Video review analysis of early common femoral arterial access in trauma: Can we identify occult shock?
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 41896154.
- Also identified by DOI 10.1016/j.injury.2026.113169.
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Abstract
Early common femoral artery (CFA) access in trauma resuscitation has the potential to improve hemodynamic monitoring and facilitate interventions. However, data on its utilization and impact are limited. This study aimed to collect objective data on early CFA access. We conducted a prospective observational study using trauma video review at a Level 1 trauma center. Critically injured trauma patients were included based on predefined criteria. Video and chart review were used to collect data on patient demographics, injury characteristics, procedural details of CFA access (including time of procedural milestones), and hemodynamic measurements. Trauma team leaders were also surveyed to determine their impressions on early arterial access. Among 72 patients, 34.7% underwent early CFA access. Early CFA access was associated with blunt mechanism (p < 0.001), lower presenting GCS (p = 0.006), and worse functional status at discharge (p = 0.028). The median time from arrival to visualizing an arterial waveform was 16.5 min (IQR 13.2, 26.2). Ultrasound improved first-pass success rates (median attempt number: 1 vs 2, p = 0.030). Noninvasive systolic blood pressure measurements were, on average, 13.5 mmHg higher than invasive measurements; the discrepancy was more pronounced in patients with arterial SBP < 90 mmHg, and 9 paired measurements revealed occult shock diagnosed only by CFA access. Early CFA access was associated with a longer time to incision (49 min [IQR 42-69] vs 34 min [IQR 26-37]; p = 0.002), but not with a delay in time to hemostasis (162 [IQR 127-220] vs 160 [IQR 92-271]; p > 0.999). Early CFA access in trauma resuscitation is feasible and can be performed rapidly, particularly with the use of ultrasound. While early CFA access may increase time to incision, it does not delay hemostasis. Further research should evaluate the direct impact of early CFA access on patient outcomes and resource utilization.