The following is a summary of “CAB versus ABC approach for resuscitation of patients following traumatic injury: Toward improving patient safety and survival,” published in the June 2023 issue of Emergency Medicine by Breeding, et al.

While the circulation-airway-breathing (CAB) resuscitation sequence has become widely accepted for administering CPR after cardiac arrest, managing complex polytraumas in adult patients remains contentious. Some guidelines prioritize airway management, while others advocate for the initial treatment of bleeding. For a study, researchers sought to evaluate existing literature comparing the ABC and CAB resuscitation sequences in adult trauma patients in the in-hospital setting. The goal was to provide evidence-based recommendations for management and identify areas for future research.

A thorough literature search was conducted on PubMed, Embase, and Google Scholar until September 29, 2022. The selected articles were assessed for comparisons between CAB and ABC resuscitation sequences, focusing on adult trauma patients, in-hospital treatment, patient volume status, and clinical outcomes.

Four studies met the inclusion criteria. Among them, two studies specifically compared CAB and ABC sequences in hypotensive trauma patients, one evaluated the sequences in trauma patients with hypovolemic shock, and the other included patients with all types of shock. Rapid sequence intubation was administered to hypotensive trauma patients before blood transfusion, and this caused a considerable drop in blood pressure and a significantly greater death rate (50% vs. 78%, P< 0.05). Patients who subsequently developed post-intubation hypotension (PIH) had increased mortality compared to those without PIH, with an overall mortality of 33.2% (250/753) in the PIH group versus 19.6% (253/1291) in the non-PIH group (P < 0.001).

According to the review, a CAB strategy for resuscitation may be more beneficial for hypotensive trauma patients, especially those actively hemorrhaging, as early intubation may increase mortality from PIH. 

However, the ABC sequence and airway prioritizing may be more advantageous for individuals with serious hypoxia or airway injury. Further prospective studies were necessary to understand the advantages of CAB in trauma patients comprehensively and to identify specific patient subgroups that are most affected by prioritizing circulation before airway management.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001018