Research indicates CAB sequence yields best results in trauma patients

Editor's Note

Trauma patients with massive bleeding may benefit from an initial focus on halting bleeding and restoring circulation over an airway-first approach, according to new findings published by the Journal of the American College of Surgeons on November 28.  

The traditional approach to trauma patients has been to first restore airways in the airway, breathing, circulation (ABC) model. But the latest literature suggests that a circulation-airway-breathing (CAB) sequence may be more beneficial. 

A team of surgeons from 10 institutions reviewed literature comparing the traditional ABC approach in resuscitating trauma patients to the newer CAB model. They found that patients suffering from massive blood loss are most vulnerable to circulatory collapse and need immediate circulation resuscitation. In one study cited in the review, CAB had a mortality rate of 12.4% vs. 23% for ABC.

The review will serve as an important guide informing modern trauma care, when there are critical seconds to determine survival. The authors note that it is especially important for those in rural areas with limited resources.