# Standardising Anaesthetic Induction in Code Red Trauma Patients: A Quality Improvement Initiative at a Major London Trauma Centre

## TL;DR

A cognitive aid was developed to help trainees manage anesthesia in critically ill trauma patients, improving confidence and consistency.

## Contribution

A standardized, trauma-specific anaesthetic induction cognitive aid was developed and evaluated in a major trauma center.

## Key findings

- Post-induction hypotension was common, with a median MAP reduction of 37%.
- Trainees reported improved confidence after using the checklist.
- The checklist was incorporated into departmental teaching.

## Abstract

Introduction

'Code red' trauma patients, defined as haemodynamically unstable with ongoing haemorrhage, are at high risk of cardiovascular collapse during anaesthetic induction. This presents a particular challenge for anaesthetic trainees unfamiliar with major trauma protocols. We aimed to develop and implement a standardised anaesthetic induction cognitive aid for 'code red' trauma patients and to describe its feasibility, uptake, and perceived educational value within a major trauma centre.

Methods

We conducted a retrospective service evaluation at a major trauma centre in London. Sixty-five patients undergoing theatre-based anaesthetic inductions between 2019 and 2023 were identified. Pre- and post-induction mean arterial pressures (MAP) were recorded from anaesthetic charts to assess peri-induction hypotension. We designed a one-page visual 'Code Red Quick Reference Guide' subsequently refined through two Plan-Do-Study-Act (PDSA) cycles, incorporating feedback from teaching sessions.

Results

Fifty-one (79%) received ketamine and fentanyl; 14 patients (21%) received propofol and fentanyl. Post-induction hypotension was common, with a median MAP reduction of 37% within 15 minutes of induction. One patient required intraoperative cardiac massage. Following checklist implementation, trainees reported improved confidence, and senior clinicians perceived greater consistency in induction planning. The checklist was incorporated into departmental teaching.

Conclusions

This quality improvement initiative demonstrated the feasibility of implementing a trauma-specific anaesthetic induction cognitive aid within a major trauma centre. While post-intervention clinical outcome data were not collected, early informal feedback supported the ongoing use of the tool as part of departmental trauma education. This project highlights the potential role of low-cost cognitive aids in supporting anaesthetic practice during high-acuity trauma care.