RT Journal Article SR Electronic T1 Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research JF Trauma Surgery & Acute Care Open JO Trauma Surg Acute Care Open FD BMJ Publishing Group Ltd SP e000773 DO 10.1136/tsaco-2021-000773 VO 6 IS 1 A1 Strauss, Rachel A1 Menchetti, Isabella A1 Perrier, Laure A1 Blondal, Erik A1 Peng, Henry A1 Sullivan-Kwantes, Wendy A1 Tien, Homer A1 Nathens, Avery A1 Beckett, Andrew A1 Callum, Jeannie A1 da Luz, Luis Teodoro YR 2021 UL http://tsaco.bmj.com/content/6/1/e000773.abstract AB Objectives The Tactical Combat Casualty Care (TCCC) guidelines detail resuscitation practices in prehospital and austere environments. We sought to review the content and quality of the current TCCC and civilian prehospital literature and characterize knowledge gaps to offer recommendations for future research.Methods MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched for studies assessing intervention techniques and devices used in civilian and military prehospital settings that could be applied to TCCC guidelines. Screening and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal was conducted using appropriate tools.Results Ninety-two percent (n=57) of studies were observational. Most randomized trials had low risk of bias, whereas observational studies had higher risk of bias. Interventions of massive hemorrhage control (n=17) were wound dressings and tourniquets, suggesting effective hemodynamic control. Airway management interventions (n=7) had high success rates with improved outcomes. Interventions of respiratory management (n=12) reported low success with needle decompression. Studies assessing circulation (n=18) had higher quality of evidence and suggested improved outcomes with component hemostatic therapy. Hypothermia prevention interventions (n=2) were generally effective. Other studies identified assessed the use of extended focused assessment with sonography in trauma (n=3) and mixed interventions (n=2).Conclusions The evidence was largely non-randomized with heterogeneous populations, interventions, and outcomes, precluding robust conclusions in most subjects addressed in the review. Knowledge gaps identified included the use of blood products and concentrate of clotting factors in the prehospital setting.Level of evidence Systematic review, level III.No data are available.