Factors related to the Emergency Medical Service initiation of vasoactive support in initially stable trauma patients

BACKGROUND AND OBJECTIVE. First responders from emergency medical services have limited diagnostic capabilities in cases of severe trauma. The clinical status of some initially stable patients worsens significantly during care and transport. We aimed to identify factors associated with prehospital initiation of vasoactive support in initially stable patients with severe trauma.
MATERIAL AND METHODS. Retrospective observational case-control study in a single emergency service in a large urban area. Patients with severe trauma attended between 2018 and 2021 were included if they were hemodynamically stable at the start of care and were transferred to a hospital. Patients who received vasoactive support (cases) were compared to those who did not (controls). We studied differences in clinical variables, vital signs, and blood test results using multivariate analysis.
RESULTS. A total of 652 patients were enrolled. Thirty-seven received vasoactive support and 615 did not. Differences were found in the following variables: systolic blood pressure, mean arterial pressure, shock index, score on the Glasgow coma scale, pH, and PCO2. Only 2 variables differed significantly on multivariate analysis. One was prehospital orotracheal intubation unrelated to cardiac arrest, with an adjusted odds ratio (aOR) of 7.51 (2.45-23.01); the other was reversed cardiac arrest witnessed by the advanced life support responders, with an aOR of 91.90 (16.08-525.09) (P < .001, both comparisons).
CONCLUSIONS. During early care for initially stable patients with severe trauma being transported to a hospital, the 2 variables associated with starting vasoactive support are prehospital orotracheal intubation unrelated to cardiac arrest and cardiac arrest reversed during attendance by an advanced life support ambulance.