Abstract Trauma care has evolved significantly over the past two decades, moving from traditional methods focused on high-volume crystalloid use to contemporary approaches centered on damage control resuscitation and structured airway management. This review outlines key advancements in trauma management from 2000 to 2025, particularly the “haemorrhage-first” approach, which prioritizes the control of severe bleeding through the xABCDE framework. Landmark trials such as clinical randomisation of an antifibrinolytic in significant haemorrhage-2, pragmatic, randomized optimal platelet and plasma ratios, and clinical randomisation of an antifibrinolytic in significant haemorrhage-3 have informed practices advocating for restrictive fluid strategies, permissive hypotension, and early use of tranexamic acid with balanced blood component ratios. The integration of viscoelastic haemostatic assays allows for real-time management of coagulopathy. Specialized interventions such as resuscitative endovascular balloon occlusion of the aorta and selective resuscitative thoracotomy have refined trauma response strategies. Improvements in airway management through video laryngoscopy and the “scalpel-bougie-tube” approach have improved advanced airway procedural success. For traumatic brain injury, the emphasis is on preventing secondary insults by carefully managing oxygen and carbon dioxide levels. Ultimately, these innovations reflect the development of robust regional trauma systems that promote multidisciplinary care and leverage real-time data for quality improvement, significantly reducing preventable mortality worldwide.
Mohamed S. A. Mohamed (2026) studied this question.