C before A: Circulation more important than airways in preventing massive blood loss, study finds

When a patient is suffering a trauma that results in massive blood loss, focusing on stopping the bleeding first and then moving to restore the airway second is the best method for patient outcomes, according to a Nov. 28 analysis from the American College of Surgeons.

Traditionally, clinicians have been taught the "ABC method," that is, to restore the airway first, breathing next and circulation last when a patient is experiencing large amounts of blood loss. 

However, an analysis of research from several institutions shows that prioritizing these things in reverse order —  the CAB method — improves chances of patient survival and overall outcomes.

In a previous study, the CAB method had a mortality rate of 12.4%, almost half that of the traditional ABC method's mortality rate of 23%.

"Patients with massive bleeding benefit from an approach in which the priority is circulation, instead of securing the airway with intubation. In patients with exsanguinating injuries, we can improve outcomes by delaying intubation and supporting the airway with other maneuvers, such as oxygen and opening the airway," stated Paula Ferrada, MD, lead author of the study, and chief of trauma and acute care surgery at Falls Church, Va.-based Inova Health System. "Those seconds can be the difference between life and death."

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