Moving the needle on time to resuscitation: An EAST prospective multicenter study of vascular access in hypotensive injured patients using trauma video review
Vascular access in hypotensive trauma patients is challenging. Little evidence exists on the time required and success rates of vascular access types. We hypothesized that intraosseous (IO) access would be faster and more successful than peripheral intravenous (PIV) and central venous catheter (CVC)...
Uložené v:
| Vydané v: | The journal of trauma and acute care surgery Ročník 95; číslo 1; s. 87 |
|---|---|
| Hlavní autori: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
United States
01.07.2023
|
| Predmet: | |
| ISSN: | 2163-0763, 2163-0763 |
| On-line prístup: | Zistit podrobnosti o prístupe |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | Vascular access in hypotensive trauma patients is challenging. Little evidence exists on the time required and success rates of vascular access types. We hypothesized that intraosseous (IO) access would be faster and more successful than peripheral intravenous (PIV) and central venous catheter (CVC) access in hypotensive patients.
An EAST prospective multicenter trial was performed; 19 centers provided data. Trauma video review was used to evaluate the resuscitations of hypotensive (systolic blood pressure ≤90 mm Hg) trauma patients. Highly granular data from video recordings were abstracted. Data collected included vascular access attempt type, location, success rate, and procedural time. Demographic and injury-specific variables were obtained from the medical record. Success rates, procedural durations, and time to resuscitation were compared among access strategies (IO vs. PIV vs. CVC).
There were 1,410 access attempts that occurred in 581 patients with a median age of 40 years (27-59 years) and an Injury Severity Score of 22 [10-34]. Nine hundred thirty-two PIV, 204 IO, and 249 CVC were attempted. Seventy percent of access attempts were successful but were significantly less likely to be successful in females (64% vs. 71%, p = 0.01). Median time to any access was 5.0 minutes (3.2-8.0 minutes). Intraosseous had higher success rates than PIV or CVC (93% vs. 67% vs. 59%, p < 0.001) and remained higher after subsequent failures (second attempt, 85% vs. 59% vs. 69%, p = 0.08; third attempt, 100% vs. 33% vs. 67%, p = 0.002). Duration varied by access type (IO, 36 [23-60] seconds; PIV, 44 [31-61] seconds; CVC 171 [105-298]seconds) and was significantly different between IO versus CVC ( p < 0.001) and PIV versus CVC ( p < 0.001) but not PIV versus IO. Time to resuscitation initiation was shorter in patients whose initial access attempt was IO, 5.8 minutes versus 6.7 minutes ( p = 0.015). This was more pronounced in patients arriving to the hospital with no established access (5.7 minutes vs. 7.5 minutes, p = 0.001).
Intraosseous is as fast as PIV and more likely to be successful compared with other access strategies in hypotensive trauma patients. Patients whose initial access attempt was IO were resuscitated more expeditiously. Intraosseous access should be considered a first line therapy in hypotensive trauma patients.
Therapeutic/Care Management; Level II. |
|---|---|
| AbstractList | Vascular access in hypotensive trauma patients is challenging. Little evidence exists on the time required and success rates of vascular access types. We hypothesized that intraosseous (IO) access would be faster and more successful than peripheral intravenous (PIV) and central venous catheter (CVC) access in hypotensive patients.
An EAST prospective multicenter trial was performed; 19 centers provided data. Trauma video review was used to evaluate the resuscitations of hypotensive (systolic blood pressure ≤90 mm Hg) trauma patients. Highly granular data from video recordings were abstracted. Data collected included vascular access attempt type, location, success rate, and procedural time. Demographic and injury-specific variables were obtained from the medical record. Success rates, procedural durations, and time to resuscitation were compared among access strategies (IO vs. PIV vs. CVC).
There were 1,410 access attempts that occurred in 581 patients with a median age of 40 years (27-59 years) and an Injury Severity Score of 22 [10-34]. Nine hundred thirty-two PIV, 204 IO, and 249 CVC were attempted. Seventy percent of access attempts were successful but were significantly less likely to be successful in females (64% vs. 71%, p = 0.01). Median time to any access was 5.0 minutes (3.2-8.0 minutes). Intraosseous had higher success rates than PIV or CVC (93% vs. 67% vs. 59%, p < 0.001) and remained higher after subsequent failures (second attempt, 85% vs. 59% vs. 69%, p = 0.08; third attempt, 100% vs. 33% vs. 67%, p = 0.002). Duration varied by access type (IO, 36 [23-60] seconds; PIV, 44 [31-61] seconds; CVC 171 [105-298]seconds) and was significantly different between IO versus CVC ( p < 0.001) and PIV versus CVC ( p < 0.001) but not PIV versus IO. Time to resuscitation initiation was shorter in patients whose initial access attempt was IO, 5.8 minutes versus 6.7 minutes ( p = 0.015). This was more pronounced in patients arriving to the hospital with no established access (5.7 minutes vs. 7.5 minutes, p = 0.001).
Intraosseous is as fast as PIV and more likely to be successful compared with other access strategies in hypotensive trauma patients. Patients whose initial access attempt was IO were resuscitated more expeditiously. Intraosseous access should be considered a first line therapy in hypotensive trauma patients.
Therapeutic/Care Management; Level II. Vascular access in hypotensive trauma patients is challenging. Little evidence exists on the time required and success rates of vascular access types. We hypothesized that intraosseous (IO) access would be faster and more successful than peripheral intravenous (PIV) and central venous catheter (CVC) access in hypotensive patients.BACKGROUNDVascular access in hypotensive trauma patients is challenging. Little evidence exists on the time required and success rates of vascular access types. We hypothesized that intraosseous (IO) access would be faster and more successful than peripheral intravenous (PIV) and central venous catheter (CVC) access in hypotensive patients.An EAST prospective multicenter trial was performed; 19 centers provided data. Trauma video review was used to evaluate the resuscitations of hypotensive (systolic blood pressure ≤90 mm Hg) trauma patients. Highly granular data from video recordings were abstracted. Data collected included vascular access attempt type, location, success rate, and procedural time. Demographic and injury-specific variables were obtained from the medical record. Success rates, procedural durations, and time to resuscitation were compared among access strategies (IO vs. PIV vs. CVC).METHODSAn EAST prospective multicenter trial was performed; 19 centers provided data. Trauma video review was used to evaluate the resuscitations of hypotensive (systolic blood pressure ≤90 mm Hg) trauma patients. Highly granular data from video recordings were abstracted. Data collected included vascular access attempt type, location, success rate, and procedural time. Demographic and injury-specific variables were obtained from the medical record. Success rates, procedural durations, and time to resuscitation were compared among access strategies (IO vs. PIV vs. CVC).There were 1,410 access attempts that occurred in 581 patients with a median age of 40 years (27-59 years) and an Injury Severity Score of 22 [10-34]. Nine hundred thirty-two PIV, 204 IO, and 249 CVC were attempted. Seventy percent of access attempts were successful but were significantly less likely to be successful in females (64% vs. 71%, p = 0.01). Median time to any access was 5.0 minutes (3.2-8.0 minutes). Intraosseous had higher success rates than PIV or CVC (93% vs. 67% vs. 59%, p < 0.001) and remained higher after subsequent failures (second attempt, 85% vs. 59% vs. 69%, p = 0.08; third attempt, 100% vs. 33% vs. 67%, p = 0.002). Duration varied by access type (IO, 36 [23-60] seconds; PIV, 44 [31-61] seconds; CVC 171 [105-298]seconds) and was significantly different between IO versus CVC ( p < 0.001) and PIV versus CVC ( p < 0.001) but not PIV versus IO. Time to resuscitation initiation was shorter in patients whose initial access attempt was IO, 5.8 minutes versus 6.7 minutes ( p = 0.015). This was more pronounced in patients arriving to the hospital with no established access (5.7 minutes vs. 7.5 minutes, p = 0.001).RESULTSThere were 1,410 access attempts that occurred in 581 patients with a median age of 40 years (27-59 years) and an Injury Severity Score of 22 [10-34]. Nine hundred thirty-two PIV, 204 IO, and 249 CVC were attempted. Seventy percent of access attempts were successful but were significantly less likely to be successful in females (64% vs. 71%, p = 0.01). Median time to any access was 5.0 minutes (3.2-8.0 minutes). Intraosseous had higher success rates than PIV or CVC (93% vs. 67% vs. 59%, p < 0.001) and remained higher after subsequent failures (second attempt, 85% vs. 59% vs. 69%, p = 0.08; third attempt, 100% vs. 33% vs. 67%, p = 0.002). Duration varied by access type (IO, 36 [23-60] seconds; PIV, 44 [31-61] seconds; CVC 171 [105-298]seconds) and was significantly different between IO versus CVC ( p < 0.001) and PIV versus CVC ( p < 0.001) but not PIV versus IO. Time to resuscitation initiation was shorter in patients whose initial access attempt was IO, 5.8 minutes versus 6.7 minutes ( p = 0.015). This was more pronounced in patients arriving to the hospital with no established access (5.7 minutes vs. 7.5 minutes, p = 0.001).Intraosseous is as fast as PIV and more likely to be successful compared with other access strategies in hypotensive trauma patients. Patients whose initial access attempt was IO were resuscitated more expeditiously. Intraosseous access should be considered a first line therapy in hypotensive trauma patients.CONCLUSIONIntraosseous is as fast as PIV and more likely to be successful compared with other access strategies in hypotensive trauma patients. Patients whose initial access attempt was IO were resuscitated more expeditiously. Intraosseous access should be considered a first line therapy in hypotensive trauma patients.Therapeutic/Care Management; Level II.LEVEL OF EVIDENCETherapeutic/Care Management; Level II. |
| Author | Maiga, Amelia W Butler, Dale F Truitt, Michael Leshikar, David Krowsoski, Leandra Berry, Stepheny Luce, Siobhan Horrigan, Tiffany Armen, Scott B Staszak, Ryan Guido, Jenny da Luz, Luis T Pannell, Dylan Grossman Verner, Heather M Estroff, Jordan Mooney, Jennifer Middlekauff, Jennifer Mathew, Sarah Margolick, Joseph Dennis, Brad M McMann, Ashley H Moore, Forrest O Hebeler, Katherine Hendzlik, Peter Alexander, Ashley Diaz, Bernardo F Dumas, Ryan P Erickson, Caroline R Bjordahl, Paul Vella, Michael A Bukur, Marko Bruce, Nolan Zebley, James A Marinica, Alexander Velopulos, Catherine G Quigley, Emily Mitchell, Sarah Holena, Daniel N Polite, Nathan M |
| Author_xml | – sequence: 1 givenname: Ryan P surname: Dumas fullname: Dumas, Ryan P organization: From the Division of Burn Trauma Acute and Critical Care Surgery (R.P.D., A.M.), UT Southwestern Medical Center, Dallas TX; Division of Acute Care Surgery (M.A.V., P.H.), University of Rochester Medical Center, Rochester, NY; Division of Acute Care Surgery (A.W.M., C.R.E., B.M.B.), Vanderbilt University Medical Center, Nashville, TN; Sunnybrook Health Sciences Centre (L.T.L., D.P.), Toronto, Canada; Section of Trauma, Acute Care Surgery and Critical Care (E.Q., C.G.V.), University of Colorado, Aurora, CO; Trauma and Acute Care Surgery (N.B., J.M.), University of Arkansas for Medical Sciences, Little Rock, AR; Traumatology, Surgical Critical Care and Emergency Surgery (D.F.B.), University of Pennsylvania, Philadelphia, PA; George Washington University, Center for Trauma and Critical Care (J.E., J.A.Z.), Washington, DC; Texas Health Harris Methodist (A.A., S.M.), Fort Worth, TX; Methodist Medical Center (H.M.G.V., M.T.), Dallas, TX; Acute Care Surgery, Trauma, and Surgical Critical Care (S.B., J.M.), University of Kansas, Kansas City, KS; UC Davis Medical Center-Trauma, Acute Care Surgery and Surgical Critical Care (S.L., D.L.), Sacramento, CA; NYU Langone Health, NY (L.K., M.B.); University of South Alabama (N.M.P., A.H.M.), Mobile, AL; Division of Trauma, Acute Care and Critical Care Surgery (R.S., S.B.A.), Penn State Health Medical Center, Hershey PA; John Peter Smith Health (T.H., F.O.M.), Fort Worth, TX; Sanford Health (P.B., J.G.), Sioux Falls, SD; Reading Hospital Tower Health (S.M., B.F.D.), Reading, PA; Baylor University Medical Center (J.M., K.H.), Dallas TX; and Division of Trauma and Acute Care Surgery (D.N.H.), Medical College of Wisconsin, Milwaukee, WI – sequence: 2 givenname: Michael A surname: Vella fullname: Vella, Michael A – sequence: 3 givenname: Amelia W surname: Maiga fullname: Maiga, Amelia W – sequence: 4 givenname: Caroline R surname: Erickson fullname: Erickson, Caroline R – sequence: 5 givenname: Brad M surname: Dennis fullname: Dennis, Brad M – sequence: 6 givenname: Luis T surname: da Luz fullname: da Luz, Luis T – sequence: 7 givenname: Dylan surname: Pannell fullname: Pannell, Dylan – sequence: 8 givenname: Emily surname: Quigley fullname: Quigley, Emily – sequence: 9 givenname: Catherine G surname: Velopulos fullname: Velopulos, Catherine G – sequence: 10 givenname: Peter surname: Hendzlik fullname: Hendzlik, Peter – sequence: 11 givenname: Alexander surname: Marinica fullname: Marinica, Alexander – sequence: 12 givenname: Nolan surname: Bruce fullname: Bruce, Nolan – sequence: 13 givenname: Joseph surname: Margolick fullname: Margolick, Joseph – sequence: 14 givenname: Dale F surname: Butler fullname: Butler, Dale F – sequence: 15 givenname: Jordan surname: Estroff fullname: Estroff, Jordan – sequence: 16 givenname: James A surname: Zebley fullname: Zebley, James A – sequence: 17 givenname: Ashley surname: Alexander fullname: Alexander, Ashley – sequence: 18 givenname: Sarah surname: Mitchell fullname: Mitchell, Sarah – sequence: 19 givenname: Heather M surname: Grossman Verner fullname: Grossman Verner, Heather M – sequence: 20 givenname: Michael surname: Truitt fullname: Truitt, Michael – sequence: 21 givenname: Stepheny surname: Berry fullname: Berry, Stepheny – sequence: 22 givenname: Jennifer surname: Middlekauff fullname: Middlekauff, Jennifer – sequence: 23 givenname: Siobhan surname: Luce fullname: Luce, Siobhan – sequence: 24 givenname: David surname: Leshikar fullname: Leshikar, David – sequence: 25 givenname: Leandra surname: Krowsoski fullname: Krowsoski, Leandra – sequence: 26 givenname: Marko surname: Bukur fullname: Bukur, Marko – sequence: 27 givenname: Nathan M surname: Polite fullname: Polite, Nathan M – sequence: 28 givenname: Ashley H surname: McMann fullname: McMann, Ashley H – sequence: 29 givenname: Ryan surname: Staszak fullname: Staszak, Ryan – sequence: 30 givenname: Scott B surname: Armen fullname: Armen, Scott B – sequence: 31 givenname: Tiffany surname: Horrigan fullname: Horrigan, Tiffany – sequence: 32 givenname: Forrest O surname: Moore fullname: Moore, Forrest O – sequence: 33 givenname: Paul surname: Bjordahl fullname: Bjordahl, Paul – sequence: 34 givenname: Jenny surname: Guido fullname: Guido, Jenny – sequence: 35 givenname: Sarah surname: Mathew fullname: Mathew, Sarah – sequence: 36 givenname: Bernardo F surname: Diaz fullname: Diaz, Bernardo F – sequence: 37 givenname: Jennifer surname: Mooney fullname: Mooney, Jennifer – sequence: 38 givenname: Katherine surname: Hebeler fullname: Hebeler, Katherine – sequence: 39 givenname: Daniel N surname: Holena fullname: Holena, Daniel N |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37012624$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkMtOwzAQRS0E4lH6BUholmxaYjuxE3YVKg8JxIKyjhxnQo0SO8R2UH-Gb6XlITGbmcW5d-7MCdm3ziIhZzSZ06SQl6vFPPlXvMjyPXLMqOCzRAq-_28-IlPv33ZUJgqeZYfkiMuEMsHSY_L56EZjXyGsESxi3SI4C8F0CMHBgD56bYIKxtkrWFhYLp5X0A_O96iDGRG62Aaj0QYcwIdYb8A1MCqvY6sGUFqj92AsrDe9C2j9TmPsWxywhn7ru1V6iP47w6Bip2A0Ne5WjwY_TslBo1qP098-IS83y9X13ezh6fb-evEw0zxL-AyxEIrzVFMUyIROMyGrXNJaMop5wTirheaCNjJPM13lTZHqhqZJU-WaypqzCbn48d2e9h7Rh7IzXmPbKosu-pLJIuOCCbpDz3_RWHVYl_1gOjVsyr-fsi8kjn7D |
| CitedBy_id | crossref_primary_10_1007_s40719_025_00291_5 crossref_primary_10_1007_s40719_025_00295_1 crossref_primary_10_1016_j_amjsurg_2024_04_027 crossref_primary_10_1097_TA_0000000000004127 crossref_primary_10_1136_tsaco_2024_001621 crossref_primary_10_1097_TA_0000000000004168 crossref_primary_10_1097_TA_0000000000004178 crossref_primary_10_1177_00031348241227169 crossref_primary_10_1136_tsaco_2024_001369 crossref_primary_10_1136_tsaco_2024_001688 crossref_primary_10_1016_j_surg_2025_109215 crossref_primary_10_1016_j_surg_2023_10_004 crossref_primary_10_1007_s40719_025_00297_z crossref_primary_10_1111_anae_16778 crossref_primary_10_1016_j_surg_2024_02_004 crossref_primary_10_1186_s44158_024_00197_9 |
| ContentType | Journal Article |
| Copyright | Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. |
| Copyright_xml | – notice: Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1097/TA.0000000000003958 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| EISSN | 2163-0763 |
| ExternalDocumentID | 37012624 |
| Genre | Multicenter Study Journal Article |
| GroupedDBID | --- .XZ .Z2 01R 1J1 5VS AAAAV AAAXR AAGIX AAHPQ AAIQE AAJCS AAMOA AAMTA AAQKA AARTV AASCR AASOK AASXQ AAUEB AAXQO ABASU ABBUW ABDIG ABVCZ ABXVJ ABZAD ACDDN ACEWG ACIJW ACILI ACLDA ACOAL ACWDW ACWRI ACXJB ACXNZ ADGGA ADHPY AEBDS AENEX AFDTB AFEXH AFSOK AFUWQ AGINI AHOMT AHQNM AIJEX AINUH AJCLO AJIOK AJNWD AJZMW AKCTQ AKULP ALKUP ALMA_UNASSIGNED_HOLDINGS ALMTX AMJPA AMKUR AMNEI AOHHW AWKKM BOYCO BQLVK BYPQX C45 CGR CUY CVF DIWNM E.X EBS ECM EEVPB EIF ERAAH EX3 FCALG FL- GNXGY GQDEL HLJTE IKREB IKYAY IN~ JG8 JK3 JK8 L-C NPM N~7 N~B OB4 OBH ODA ODMTH OHYEH OJAPA OLW ONV OPUJH OVD OVDNE OVIDH OVLEI OVOZU OWBYB OXXIT PONUX RLZ S4R S4S TEORI TSPGW V2I WOW 7X8 ABPXF ABXYN ABZZY ACBKD ACDOF ACZKN ADKSD ADSXY AFBFQ AFMBP AFNMH AHQVU AOQMC |
| ID | FETCH-LOGICAL-c3503-ee96a334c1e6e26c4567b871d721e89232d6c361f7845cb8f94cf140fb8c17d32 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 0 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=001020223600014&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 2163-0763 |
| IngestDate | Sun Nov 09 09:24:34 EST 2025 Wed Feb 19 02:23:22 EST 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 1 |
| Language | English |
| License | Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c3503-ee96a334c1e6e26c4567b871d721e89232d6c361f7845cb8f94cf140fb8c17d32 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| PMID | 37012624 |
| PQID | 2795362613 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2795362613 pubmed_primary_37012624 |
| PublicationCentury | 2000 |
| PublicationDate | 2023-07-01 20230701 |
| PublicationDateYYYYMMDD | 2023-07-01 |
| PublicationDate_xml | – month: 07 year: 2023 text: 2023-07-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | The journal of trauma and acute care surgery |
| PublicationTitleAlternate | J Trauma Acute Care Surg |
| PublicationYear | 2023 |
| SSID | ssj0000569355 |
| Score | 2.5020995 |
| Snippet | Vascular access in hypotensive trauma patients is challenging. Little evidence exists on the time required and success rates of vascular access types. We... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 87 |
| SubjectTerms | Adult Central Venous Catheters Emergency Medical Services Female Humans Infusions, Intraosseous Infusions, Intravenous Injections, Intravenous Prospective Studies Resuscitation |
| Title | Moving the needle on time to resuscitation: An EAST prospective multicenter study of vascular access in hypotensive injured patients using trauma video review |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/37012624 https://www.proquest.com/docview/2795362613 |
| Volume | 95 |
| WOSCitedRecordID | wos001020223600014&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1JS8NAFB7UevDiglvdeILX0GYmmUy8SBHFS0vBCr2VZBZUNKldBP-Mv9X3JomeBMEcAjmESWZ72zffx9iFkJI77mwQE89QFKs0yE03DrixaehiTxLnxSaSwUCNx-mwTrjNa1hlsyf6jdqUmnLkHZ5QoRH9fXE1fQtINYqqq7WExiprCXRlCNKVjNV3jgWNO9GHk75cSOVKXEsN8VCadEa9irywvkQaq9_dTG9ubrf--6HbbLN2NKFXzYwdtmKLXfbZ9wkEQK8PCrRbLxbKAkhfHhYlYOS9RItYFecvoVfATe9-BNh-cx4TPP6QAJ12Bp6ZFkoHDZoVMq--CE8FPH5Myxobj4_Py5k1UFO4zoGw9vgNs2z5mgGdA6Sm6a_22MPtzej6LqgVGgItcBwDa1OZCRHp0ErLpUZvLMkxBDMYV1qFviM3UgsZukRFsc6VSyPtMKRzudJhYgTfZ2tFWdhDBrnQXaOEka7rom4UZjxzoTVKOYyhQ23b7Lzp7gmuACprZIUtl_PJT4e32UE1ZpNpRdUxEQkaYMmjoz-8fcw2SEu-wuKesJbD9W9P2bp-XzzNZ2d-auF9MOx_ASsM2lw |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Moving+the+needle+on+time+to+resuscitation%3A+An+EAST+prospective+multicenter+study+of+vascular+access+in+hypotensive+injured+patients+using+trauma+video+review&rft.jtitle=The+journal+of+trauma+and+acute+care+surgery&rft.au=Dumas%2C+Ryan+P&rft.au=Vella%2C+Michael+A&rft.au=Maiga%2C+Amelia+W&rft.au=Erickson%2C+Caroline+R&rft.date=2023-07-01&rft.eissn=2163-0763&rft.volume=95&rft.issue=1&rft.spage=87&rft_id=info:doi/10.1097%2FTA.0000000000003958&rft_id=info%3Apmid%2F37012624&rft_id=info%3Apmid%2F37012624&rft.externalDocID=37012624 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2163-0763&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2163-0763&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2163-0763&client=summon |