Background Survival differences between injured females and males have been demonstrated. Study Objectives To analyze trauma survival stratified by sex and age for a given transfusion volume. Methods The Trauma Quality Improvement Program registry was analyzed from 2020 to 2023. Patients ≥15 years who received any volume of blood products within 4 hours were included. Results There were 13,987 patients (3165/13,987, 22.6% female) who received 75–600 mL/kg of all blood products within the first 4 hours of admission, i.e., the range where a difference in cumulative 24-hour survival between males and females was observed. In this range, the cumulative probability of 24-hour survival was lower for females compared to males (46 vs. 51%, respectively). This difference was not observed in the adjusted analysis (odds ratio 0.93, 95% confidence interval 0.84–1.02). In the unadjusted age and sex subanalysis, females >50 years had the highest mortality of any of the four groups of patients once ∼100 mL/kg of blood products had been transfused. Both males and females aged 15–50 years had the lowest mortality for any volume of transfusion; males >50 years had intermediate mortality. In the regression analysis performed on patients who received a total volume of 100–600 mL/kg of transfusion, 15- to 50-year-old males had significantly lower 24-hour survival compared to similarly aged females. There was no difference in this parameter between the females and males who were >50 years. Conclusion Adjusting for differences did not reveal a difference in overall survival between males and females; younger males had lower survival compared to similarly aged females.
Background: Supraglottic airways (SGAs) are critical rescue devices in emergency airway management and provide effective oxygenation in most failed intubations. Current airway algorithms recommend availability of a supraglottic airway but do not distinguish between device classes. Laryngeal mask-style SGAs create a perilaryngeal seal over the glottic inlet, whereas laryngeal tube-style devices create a hypopharyngeal seal with dual cuffs. Because these devices seal in different anatomic locations, they may fail for different reasons. Case Reports: We report two emergency department cases in which ventilation failed with a laryngeal mask-style SGA but succeeded immediately after placement of a laryngeal tube-style device. In the first case, a patient with previously unrecognized Klippel-Feil syndrome developed hypoxemia after failed intubation and ineffective ventilation through a laryngeal mask-style device; oxygenation was restored with a laryngeal tube, avoiding surgical airway. In the second case, a patient with penetrating neck trauma could not be ventilated with a laryngeal mask-style device despite repositioning, but ventilation was immediately successful with a laryngeal tube, allowing controlled intubation. Why Should an Emergency Physician Be Aware of This?: These cases suggest that supraglottic airways are not interchangeable and that access to more than one device class may provide an important safety margin during airway rescue. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
