The ATLS® classification of hypovolaemic shock: A well established teaching tool on the edge?

Mutschler, Manuel; Paffrath, Thomas; Wölfl, Christoph; Probst, Christian; Nienaber, Ulrike; Schipper, I.B.; Bouillon, Bertil; Maegele, Marc

doi:10.1016/j.injury.2014.08.015

Cited by 75 publications

(67 citation statements)

References 15 publications

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“…Similar patterns were reported in a recent randomized, blinded controlled trial . These findings are not surprising as the loss of 450 cc of blood is equivalent to what is known as Class 1 shock, which is not expected to affect heart rate or blood pressure . Other studies evaluating the physiologic consequence of blood donation also failed to demonstrate recognizable changes in heart rate or systolic blood pressure .…”

Section: Discussionsupporting

confidence: 79%

Cognitive and physical performance are well preserved following standard blood donation: A noninferiority, randomized clinical trial

et al. 2020

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BACKGROUND A walking blood bank (WBB) refers to the use of fellow combatants for battlefield blood donation. This requires pretesting combatants for infectious diseases and blood type. A fundamental prerequisite for this technique is that the donating soldier will suffer minimal physiological and mental impact. The purpose of the current study is to assess the effect of blood shedding on battlefield performance. METHODS This is a double‐blind randomized control trial. Forty Israel Defense Forces combatants volunteered for the study. Participants underwent baseline evaluation, including repeated measurement of vital signs, cognitive evaluation, physical evaluation, and a strenuous shooting test. Three weeks after the baseline evaluation, subjects were randomized to either blood donation or the control group. For blinding purposes, all subjects underwent venous catheterization for the duration of a blood donation. Repeated vital signs and function evaluation were then performed. RESULTS Thirty‐six patients were available for randomization. Baseline measurements were similar for both groups. Mean strenuous shooting score was 80.5 ± 9.5 for the control group and 82 ± 6.6 for the test group (p = 0.58). No clinically or statistically significant differences were found in tests designed to evaluate cognitive performance or physical functions. Vital signs taken multiple times were also similar between the test and control groups. CONCLUSIONS Executive, cognitive, and physical functions were well preserved after blood donation. This study supports the hypothesis that a WBB does not decrease donor combat performance. The categorical prohibition of physical exercise following blood donation might need to be reconsidered in both military and civilian populations.

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Section: Discussionsupporting

confidence: 79%

Cognitive and physical performance are well preserved following standard blood donation: A noninferiority, randomized clinical trial

et al. 2020

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“…As is known from trauma, it is consistently difficult to diagnose shock and maybe more so in the elderly. 18,19 Cardiac arrest was found to have a high OR for death but is not a significant predictor, probably because of the low number of patients observed (seven in the group of patients who died, one in the survivor group).…”

Section: Discussionmentioning

confidence: 95%

Comparing the accuracy of four prognostic scoring systems in patients operated on for ruptured abdominal aortic aneurysms

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Vetrhus

2017

Journal of Vascular Surgery

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“…The ATLS -classification has been criticized as a mere teaching tool rather than a practical guideline, as the postulated classes are rarely found in real-life scenarios [8].…”

Section: The Advanced Trauma Life Support (Atls ) Classification Of Hmentioning

confidence: 99%

Relative blood loss in forensic medicine—do we need a change in doctrine?

et al. 2020

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In forensic medicine, blood loss is encountered frequently, either as a cause of death or as a contributing factor. Here, risk to life and lethality assessment is based on the concept of relative blood loss (absolute loss out of total volume). In emergency medicine, the Advanced Trauma Life Support (ATLS) classification also refers to relative blood loss. We tested the validity of relative blood loss benchmarks with reference to lethality. Depending on the quality of the total blood volume (TBV) estimation formula, relative blood loss rates should be reflected in the case cohort as significantly higher absolute blood loss in heavier individuals since all TBV estimation formulas positively correlate body weight with TBV. Method: 80 autopsy cases with sudden, quantifiable, exclusively internal blood loss were retrospectively analyzed and a total of 8 different formulas for TBV estimation were applied. Results: No statistical correlation between body weight and absolute blood loss was found for any of the tested TBV estimation algorithms. All cases showed a wide spread of both absolute and relative blood loss. Discussion: The principle of relative blood loss is of very limited use in casework. It opens the forensic expert opinion to unnecessary criticism and possible negative legal implications. Conclusion: We challenge the use of relative blood loss benchmarks in textbooks and practical casework and advocate for its elimination from the ATLS 's grading system. If necessary, we recommend the use of BMI-adjusted algorithms for TBV estimation.

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The ATLS® classification of hypovolaemic shock: A well established teaching tool on the edge?

Cited by 75 publications

References 15 publications

Cognitive and physical performance are well preserved following standard blood donation: A noninferiority, randomized clinical trial

Cognitive and physical performance are well preserved following standard blood donation: A noninferiority, randomized clinical trial

Comparing the accuracy of four prognostic scoring systems in patients operated on for ruptured abdominal aortic aneurysms

Relative blood loss in forensic medicine—do we need a change in doctrine?

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