Table 3 Trial interventions and comparators by group
From: Randomised controlled trials in pre-hospital trauma: a systematic mapping review
Intervention category | Total number of participants (median) | Interventions | Comparator | HCP delivering intervention | Transport mechanism |
|---|---|---|---|---|---|
Fluid therapy (n = 7) | 4202 (229) | - 500 mL of intravenous crystalloids and colloids (n = 1) | - Delayed or no infusion of intravenous fluids | - Paramedics | - Land based services |
- 250 mL intravenous infusion of 7.5% hypertonic saline and standard intravenous resuscitation fluids (crystalloids, Ringer’s lactate solution or colloids) (n = 1) | - 250 mL Ringer’s lactate solution and standard intravenous resuscitation fluids (crystalloids and colloids) | - Advanced life support paramedics | - Land based and air medical services | ||
- 250 mL hypertonic saline/colloid (7.5%/6%) or hypertonic saline (7.5%) (n = 2) | - Normal saline (0.9%) (n = 2) | - EMS personnel (n = 2) | - Land based and air medical services (n = 2) | ||
- 250 mL hypertonic saline/colloid (7.5%/6%) followed by Ringer’s lactate solution (non-racemic, L-lactate only) (n = 1) | - Conventional resuscitation and 250 mL Ringer’s lactate solution | - EMS personnel | - Land based and air medical services | ||
- 300 mL hypertonic saline 7.5% (n = 1) | - Conventional resuscitation (crystalloids and/or colloids) | - Emergency physicians | - Air medical services | ||
- 250 cc normal saline and 500 cc bottle of water (n = 1) | - 1000 cc normal saline and 2 l of fluid | - Advanced life support EMS | - Land based and air medical services | ||
Analgesia (n = 7) | 630 (101) | - 100 mg tramadol, more if required (up to 200 mg) (n = 1) | - 5 or 10 mg morphine, more if required | - Emergency physician | - Land based services |
- True acupressure; points Di4 (Hegu), KS9 (Schongchong), KS6 (Neiguan), BL60 (Kunlun), and LG20 (Baihui) (n = 1) | - False or no acupressure (n = 1) | - Paramedics | - Land based services | ||
- Diclofenac-ratiopharm Gel (1, 3% or 5%) 2-4 g twice daily (n = 1) | - Placebo gel | - Investigator and patient | - Land based services | ||
- Opioid titration protocol; intravenous 0.15 g/kg sufentanil followed by 0.075 g/kg until pain relief (n = 1) | - Intravenous 0.15 mg/kg morphine followed by 0.075 mg/kg until pain relief | - Physician, nurse, and EMT | - Land based services | ||
- Ketamine diluted in normal saline solution (10 mg/mL) after initial dose of morphine 5 mg intravenously (n = 1) | - Morphine diluted in normal saline solution (10 mg/9 mL) after initial dose of morphine 5 mg intravenously | - Paramedics | - Land based services | ||
- Pre-mixed 50% N2O and oxygen 9 L/min inhalation (n = 1) | - Medical air 9 L/min for 15 min followed by premixed 50% N2O and oxygen | - Nurse in Firefighter Emergency Services | - Land based services | ||
- Single shot peripheral block proximal to injury location under ultrasound guidance (n = 1) | - Intravenous analgesia using standard technique of s-ketamine combined with midazolam, in some cases fentanyl | - Emergency physicians | - Land based and air medical services | ||
Blood product (n = 3) | 1381 (523) | - Up to 6 U (50 g haemoglobin/unit) of PolyHeme from scene of injury and during first 12 h post-injury (n = 1) | - Crystalloids in the field and red blood cells as needed in hospital | - Paramedics | - Land based and air medical services |
- Thawed plasma (n = 2) | - Frozen water and normal saline (0.9%) as per standard care (n = 1) - Standard care resuscitation defined by local protocol (n = 1) | - Paramedics (n = 1) - Air medical personnel and physicians (n = 1) | - Land based services (n = 1) - Air medical services (n = 1) | ||
Temperature management (n = 3) | 659 (100) | - Resistive heating; carbon-fiber electric heating blanket set to 42 °C (n = 1) | - Passive warming | - Paramedics | - Land based services |
- A heating pad reaching 50 °C applied across anterior upper torso (n = 1) | - Polyester, woollen and rescue blankets | - EMS personnel | - Land based and air medical services | ||
- Prophylactic hypothermia by bolus of up to 2000 mL intravenous 4 °C saline (0.9%) and surface-cooling wraps targeting core temperature of 35 °C (n = 1) | - Normothermia; no exposure or cold fluids and warmed if required | - Emergency physicians | - Land based services | ||
Airway management/ventilation (n = 2) | 409 (204.5) | - Monitor; ventilation adjusted to achieve end-tidal carbon dioxide determined according to clinical condition of each patient, ventilation determined by weight of patients on admission (n = 1) | - Monitor-blind; ventilation set by using a tidal-volume of 10 mL kg−1 estimated body weight and age-appropriate ventilatory frequency | - Trauma anaesthesiologist and paramedic | - Air medical services |
- Pre-hospital intubation by paramedics (n = 1) | - In hospital intubation | - Intensive care paramedics | - Land based services | ||
Model of care (n = 1) | 3124 N/A | - Physician team in addition to standard response team (n = 1) | - Standard care by paramedics only | - Physicians and paramedics | - Air medical services |