Critical evaluation of studies embracing major changes to the new ATLS course manual

Abstract

Advanced Trauma Life Support (ATLS) has become the world's best-known professional trauma education program. It is a two-day program that teaches knowledge and techniques of evaluation and management of trauma victims. The program is presented through a combination of interactive lectures, surgical skill instruction, case-based skill stations, and group discussions. It provides a common language and approach, allowing participants to have a shared mindset about the systematization of care. The ATLS was based on the assumption that appropriate and timely care could significantly improve the outcome of trauma patients. Currently, the ATLS method is accepted as a standard for the "first hour" care of the trauma, whether the patient is treated in an isolated rural area or in an advanced trauma center. The ATLS program has a manual, written by experts from each medical field, to better assist traumatic emergencies. Its guidelines are the key determinants of management of trauma patients in almost every health care facility in the world. In its new 10th edition, it promoted changes in key aspects of these guidelines (eg, relocation of thoracentesis and use of tranexamic acid), which were readily accepted by all practitioners in the area. However, the ATLS Course Manual does not describe the level of evidence for these updates, which leads us to question whether these new recommendations are indeed effective and safe. Therefore, our objective, through this work, is to systematically review the literature in search of the studies that support the main changes in the new edition of the Course Manual for Students of Advanced Life Support in Trauma and to critically evaluate the studies with the highest degree of evidence. The following interventions will be evaluated in the new edition of the ATLS: place to perform thoracentesis for hypertensive pneumothorax (second space versus fifth intercostal space); total infused crystalloid volume for hemorrhagic shock (liberal vs. restrictive infusion); tranexamic acid for hemorrhage; protocol for massive transfusion for hemorrhagic shock; tube size for chest drainage (larger versus smaller tube); base excess for hemorrhagic shock; rectal touch for pelvic fracture; new Glasgow Coma Scale for traumatic brain injury.