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Venous access is a key component of managing haemorrhagic shock. Obtaining intravenous access in trauma patients is challenging due to circulatory collapse in shock. This literature review examines the feasibility of direct puncture and cannulation of the brachiocephalic veins (BCVs) for intravenous access in shocked adult trauma patients. Three literature searches were conducted. OVID Medline was searched for articles on the use of the BCVs for venous access in adults and on the BCVs in shock. A third systematic search of OVID Medline, OVID Embase and Cochrane Library was conducted on the use of the BCVs for access in shocked trauma patients. After full‐text review, 18 studies were selected for inclusion for the search on the use of the BCVs for access in adults. No studies met the inclusion criteria for the search on the BCVs in shock and BCV access in shocked trauma patients. The BCVs are currently used for central venous access, haemodialysis and totally implantable venous access devices (TIVADs) in adults. There is a preference for the right BCV (RBCV) over the left as the RBCV is more superficial, straighter, larger, has less anatomical variation and avoids the risk of thoracic duct puncture. The BCVs appear to be stabilised in shock by surrounding bony structures. The BCVs may provide a site for initial, rapid access in trauma resuscitation. Further research is required to determine if the BCVs collapse in shock and if venous access using the BCVs is feasible in a trauma resuscitation setting. [ABSTRACT FROM AUTHOR]

Background: The neutrophil-to-lymphocyte ratio has been proposed as a marker of systemic inflammation in major trauma patients that is associated with in-hospital mortality. However, the initial neutrophil-to-lymphocyte ratio does not appear to be predictive of in-hospital mortality. The aim of this study is to determine the discriminative ability of the neutrophil-to-lymphocyte ratio profile over 48 h as a predictor of in-hospital mortality following major trauma. Methods: This was a case-control study involving all major trauma patients meeting the criteria for inclusion into the Alfred Health Trauma Registry who presented directly from the scene of injury over a 24-month period. Patients were then divided into two groups, cases being major trauma patients who died at hospital discharge and controls being patients who survived. We extracted data for Day 0, Day 1 and Day 2 neutrophil-to-lymphocyte ratio values for each patient. The primary outcome was mortality at hospital discharge. Results: Data were extracted for 1689 major trauma patients, of which 72% were male, the median age was 49 years (IQR 31–68) and most (90%) patients presented after a blunt mechanism of injury. There were 165 cases that were compared to 1524 controls. Patients who died were older (p < 0.001), and had higher injury severity scores (p < 0.001) and lower revised trauma scores (p < 0.001). Analysis of response profiles demonstrated a significant difference between the trajectories of the neutrophil-to-lymphocyte ratio over time (p < 0.001). Conclusions: The profile of neutrophil-to-lymphocyte ratio over 48 h after injury shows promise as a prognostic tool in trauma and warrants further investigation. [ABSTRACT FROM AUTHOR]