Division of Trauma, Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio.
OhioHealth, Grant Medical Center, Department of Surgery, Columbus, Ohio.
J Surg Res. 2019 Jan;233:132-138. doi: 10.1016/j.jss.2018.07.074. Epub 2018 Aug 21.
Tranexamic acid (TXA) has been shown to reduce mortality in the treatment of traumatic hemorrhage. This effect seems most profound when given early after injury. We hypothesized that extending a protocol for TXA administration into the prehospital aeromedical setting would improve outcomes while maintaining a similar safety profile to TXA dosed in the emergency department (ED).
We identified all trauma patients who received TXA during prehospital aeromedical transport or in the ED at our urban level I trauma center over an 18-mo period. These patients had been selected prospectively for TXA administration using a protocol that selected adult trauma patients with high-risk mechanism and concern for severe hemorrhage to receive TXA. Patient demographics, vital signs, lab values including thromboelastography, blood administration, mortality, and complications were reviewed retrospectively and analyzed.
One hundred sixteen patients were identified (62 prehospital versus 54 ED). Prehospital TXA patients were more likely to have sustained blunt injury (76% prehospital versus 46% ED, P = 0.002). There were no differences between groups in injury severity score or initial vital signs. There were no differences in complication rates or mortality. Patients receiving TXA had higher rates of venous thromboembolic events (8.1% in prehospital and 18.5% in ED) than the overall trauma population (2.1%, P < 0.001).
Prehospital administration of TXA during aeromedical transport did not improve survival compared with ED administration. Treatment with TXA was associated with increased risk of venous thromboembolic events. Prehospital TXA protocols should be refined to identify patients with severe hemorrhagic shock or traumatic brain injury.
氨甲环酸（TXA）已被证明可降低创伤性出血患者的死亡率。这种效果在受伤后早期给予时似乎最为明显。我们假设，将 TXA 给药方案扩展到院前航空医疗环境中，将改善治疗效果，同时保持与急诊科（ED）给药相似的安全性。
我们在 18 个月的时间内，确定了在我们的城市一级创伤中心接受院前航空医疗转运或 ED 中 TXA 治疗的所有创伤患者。这些患者已通过使用选择具有高危机制和严重出血风险的成年创伤患者接受 TXA 的方案，前瞻性地选择接受 TXA 治疗。回顾性审查和分析患者的人口统计学、生命体征、实验室值（包括血栓弹力图）、血液输注、死亡率和并发症。
共确定了 116 名患者（62 名院前与 54 名 ED）。院前 TXA 患者更有可能发生钝性损伤（76%的院前与 46%的 ED，P=0.002）。两组间在损伤严重程度评分或初始生命体征上无差异。并发症发生率或死亡率无差异。接受 TXA 治疗的患者静脉血栓栓塞事件发生率（院前 8.1%，ED 18.5%）高于总体创伤人群（2.1%，P<0.001）。
与 ED 给药相比，航空医疗转运期间院前给予 TXA 并未提高生存率。TXA 治疗与静脉血栓栓塞事件风险增加相关。应改进院前 TXA 方案，以识别有严重出血性休克或创伤性脑损伤的患者。
