Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis.

BACKGROUND: Helicopters have become a major part of the modern trauma care system and are frequently used to transport patients from the scene of their injury to a trauma center. While early studies reported decreased mortality for trauma patients transported by helicopters when compared with those transported by ground ambulances, more recent research has questioned the benefit of helicopter transport of trauma patients. The purpose of this study was to determine the percentage of patients transported by helicopter who have nonlife-threatening injuries. METHODS: A meta-analysis was performed on peer-review research on helicopter utilization. The inclusion criteria were all studies that evaluated trauma patients transported by helicopter from the scene of their injury to a trauma center with baseline parameters defined by Injury Severity Score (ISS), Trauma Score (TS), Revised Trauma Score (RTS), and the likelihood of survival as determined via Trauma Score-Injury Severity Score (TRISS) methodology. RESULTS: There were 22 studies comprising 37,350 patients that met the inclusion criteria. According to the ISS, 60.0% [99% confidence interval (CI): 54.5-64.8] of patients had minor injuries, According to the TS, 61.4% (99% CI: 60.8-62.0) of patients had minor injuries. According to TRISS methodology, 69.3% (99% CI: 58.5-80.2) of patients had a greater than 90% chance of survival and thus nonlife-threatening injuries. There were 25.8% (99% CI: -1.0-52.6) of patients discharged within 24 hours after arrival at the trauma center. CONCLUSIONS: The majority of trauma patients transported from the scene by helicopter have nonlife-threatening injuries. Efforts to more accurately identify those patients who would benefit most from helicopter transport from the accident scene to the trauma center are needed to reduce helicopter overutilization.

Improving the hemodynamics of CPR. AHA guidelines support timely and effective CPR.

More research is needed to improve our understanding of what constitutes the most effective method of cardiopulmonary resuscitation; however, we know more now than ever in the history of medicine. We know that CPR is more than simply pushing on the chest and defibrillating the heart. We know that there exists an optimal physiologic condition to facilitate successful resuscitation that relies on quality coronary and cerebral artery perfusion and preparation of the heart before defibrillation. There are many questions yet to be answered, such as how long defibrillation should be delayed following CPR, which devices or techniques provide the most effective CPR, and what are the most effective ratios of compression and ventilation? The answer may lie within a combination of approaches using multiple devices and techniques simultaneously in an attempt to meet the goals for performing the most effective CPR. What is clear is that the science of cardiac arrest is maturing, and what began in the early ages as an act of faith and desperation has now become grounded in logical reason and understanding of the physiology of cardiac arrest and the hemodynamics of CPR.