Multi-lumen catheter insertion during trauma resuscitation: assessing clinical outcomes and complications

Background Massive transfusion is essential in trauma resuscitation; however, reliable, high-flow vascular access remains challenging. The multi-lumen access catheter (MAC) was designed as a trauma-dedicated central line enabling rapid transfusion. However, evidence on the optimal MAC insertion site is limited. This study compared clinical outcomes and complications of subclavian vein (SCV) vs. femoral vein (FV) MAC placement in severely injured patients. Methods This retrospective study was conducted at a single Level I trauma center between January 2019 and December 2022. Adult patients (≥ 18 years) with blunt trauma, Injury Severity Score ≥ 15, MAC placement during initial trauma bay resuscitation were included. All patients fulfilled criteria for massive transfusion. Primary outcomes included 30-day mortality and insertion site-related complications, categorized as FV or SCV. Mortality predictors were evaluated using multivariable logistic regression. Subgroup analysis examined patients with severe abdominal or pelvic injuries (Abbreviated Injury Scale [AIS] ≥ 3) to evaluate outcomes by insertion above or below the diaphragm. Results In total, 412 patients were analyzed (SCV 224, 54.4%; FV 188, 45.6%). Patients in the FV group had lower Glasgow Coma Scale (GCS) and higher lactate levels, whereas severe pelvic injuries were more frequent in the SCV group. Procedural complications differed by site: failed catheterization was more frequent with SCV (9.0% vs. 2.1%), alongside pneumothorax (5.7%) and malposition (3.3%). Thromboembolic complications showed opposite patterns: deep vein thrombosis was more common in the FV group (18.1% vs. 5.4%), whereas pulmonary thromboembolism was higher in the SCV group (4.0% vs. 0.5%). No central line–associated bloodstream infection was observed. Thirty-day mortality was higher in the FV group (25% vs. 15.2%); however, insertion site was not an independent mortality predictor. Mortality predictors included age, low mean arterial pressure, low GCS, elevated lactate, and severe head/neck, chest, or extremity injuries. In the abdominal/pelvic AIS ≥ 3 subgroup, outcomes did not differ by insertion site. Conclusion MAC insertion during trauma resuscitation was feasible and effective, with distinct complication profiles between SCV and FV access. Mortality was determined by physiology and injury severity, not catheter site. Vascular access decisions should be individualized, balancing technical feasibility, injury pattern, and complication risk.