Authors: Hogan A et al.
Cureus, Volume 18, Issue 1, Article e101769, January 2026. DOI: 10.7759/cureus.101769.
Summary
This quality improvement/service evaluation project addressed a high-risk moment in trauma anesthesia: induction for “code red” patients (hemodynamically unstable with ongoing hemorrhage) who are vulnerable to cardiovascular collapse, particularly when managed by trainees who may be less familiar with major trauma workflows. The team’s goal was to create and implement a standardized, one-page cognitive aid (“Code Red Quick Reference Guide”) for anesthetic induction, and to describe feasibility, uptake, and perceived educational value at a major London trauma center.
The authors retrospectively reviewed 65 theater-based trauma inductions (2019–2023) and recorded pre- and post-induction mean arterial pressures (MAP) to characterize peri-induction hypotension. In practice, most patients received ketamine with fentanyl (79%), while a smaller group received propofol with fentanyl (21%). Post-induction hypotension was common, with a median MAP drop of 37% within 15 minutes of induction, and one patient required intraoperative cardiac massage—underscoring how precarious these inductions can be even in experienced centers.
They then developed the cognitive aid and refined it through two Plan-Do-Study-Act (PDSA) cycles using feedback from teaching sessions. After implementation, trainees reported improved confidence and senior clinicians perceived greater consistency in induction planning. The guide was incorporated into departmental teaching, supporting the concept that a low-cost, standardized prompt can help structure preparation and decision-making in high-acuity, high-stress scenarios. Importantly, the project did not collect post-intervention clinical outcome data, so its demonstrated impact is primarily on feasibility, adoption, and perceived educational/behavioral consistency rather than measured patient outcomes.
What You Should Know
Code red trauma inductions have a high incidence of early post-induction hypotension; in this cohort the median MAP fell substantially within 15 minutes.
A simple, trauma-specific induction cognitive aid was feasible to implement and was adopted into teaching, with reported improvements in trainee confidence and perceived planning consistency.
This was not an outcomes study after rollout; the main “win” demonstrated here is standardization and education rather than proven reduction in hypotension or complications.
If you deploy a similar tool, pair it with deliberate teaching, repeated feedback cycles (PDSA), and a plan to track objective outcomes after implementation.
Key Points
Problem: High-risk induction physiology in actively bleeding, unstable trauma patients; variability in trainee approach.
Intervention: One-page “Code Red Quick Reference Guide,” refined via two PDSA cycles and embedded into teaching.
Baseline finding: Hypotension after induction was common, with a large early MAP drop; rare extreme deterioration occurred.
Effect observed: Improved trainee confidence and perceived consistency of induction planning; no post-intervention outcome measurement.
Thank you for allowing us to use and summarize this article from Cureus.