Article Text
Abstract
Objectives The Tactical Combat Casualty Care (TCCC) guidelines detail resuscitation practices in prehospital and austere environments. We sought to review the content and quality of the current TCCC and civilian prehospital literature and characterize knowledge gaps to offer recommendations for future research.
Methods MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched for studies assessing intervention techniques and devices used in civilian and military prehospital settings that could be applied to TCCC guidelines. Screening and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal was conducted using appropriate tools.
Results Ninety-two percent (n=57) of studies were observational. Most randomized trials had low risk of bias, whereas observational studies had higher risk of bias. Interventions of massive hemorrhage control (n=17) were wound dressings and tourniquets, suggesting effective hemodynamic control. Airway management interventions (n=7) had high success rates with improved outcomes. Interventions of respiratory management (n=12) reported low success with needle decompression. Studies assessing circulation (n=18) had higher quality of evidence and suggested improved outcomes with component hemostatic therapy. Hypothermia prevention interventions (n=2) were generally effective. Other studies identified assessed the use of extended focused assessment with sonography in trauma (n=3) and mixed interventions (n=2).
Conclusions The evidence was largely non-randomized with heterogeneous populations, interventions, and outcomes, precluding robust conclusions in most subjects addressed in the review. Knowledge gaps identified included the use of blood products and concentrate of clotting factors in the prehospital setting.
Level of evidence Systematic review, level III.
- resuscitation
Data availability statement
No data are available.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Data availability statement
No data are available.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
RS and IM contributed equally.
Contributors LTdL, RS, IM, and LP conceived and designed the study. RS, IM, and LP led the production of the review across the different phases, supervised by LTdL, who is the methodology expert and senior author. RS, IM, and LP led the entire screening process, data retrieving, and analyses as per the PRISMA protocol, with the other authors (EB, HP, WS-K, HT, AN, AB, and JC). These processes were monitored by LTdL. HT, AB, JC, and AN were the content experts and contributed significantly to the article review. RS and IM along with the assistance of LP drafted the article and were supervised by LTdL. All authors contributed to the revision of the article. All authors have seen and approved the final article version. RS and IM take responsibility for the article as a whole.
Funding This article was performed for Task 47 under a research contract W7714-145967 with the Defence Research and Development Canada (DRDC).
Competing interests JC received research support from Canadian Blood Services and Octapharma.
Provenance and peer review Not commissioned; externally peer reviewed.