Copy
This is your daily JournalFeed.
View this email in your browser
JournalFeed

Prehospital TXA for Trauma - Meta-analysis

Mar 18, 2021 01:00 am

Written by Cliff Freeman

Spoon Feed
When given by prehospital providers for suspected significant hemorrhage, TXA reduces 24-hour mortality but doesn’t affect 28-30-day mortality.


Tarlan Hedayati teaches about the paracentesis gone wrong

This CME content brought to you through the joint providership of Hippo Education and JournalFeed.

This CME content brought to you through the joint providership of Hippo Education and JournalFeed.


Why does this matter?
We have been searching for ways to improve mortality and morbidity in trauma since there has been trauma.  CRASH 2 increased interest in tranexamic acid as the potential lifeblood. CRASH 3 suggested improvement in mortality for TBI with a GCS >9, particularly if given early. Well, it doesn’t get any earlier than in an ambulance. So, does it work?

Don’t stop believing?
This is a systematic review and meta-analysis of four studies (3 observational, 1 RCT - STAAMP) in which prehospital TXA was given for significant traumatic hemorrhage. Three studies looked at mortality in the first 24 hours. The TXA group had 1076 total patients and the no-TXA cohort had 1073. There was a 40% reduction in the odds of death with TXA (n=38) compared to without (n=62), OR 0.60 (95%CI 0.37-0.99], p=0.05). Three studies also recorded mortality between 28 and 30 days. The TXA group included 1062 patients and no-TXA had 1072. There was no statistical difference here, with 85 deaths in the TXA group and 117 in the no-TXA cohort, OR 0.69 (95%CI 0.47-1.02, p=0.06). All four studies reported the incidence of venous thromboembolism, and there was no statistical significance here either but a possible signal of increased clotting in the TXA group. This seems to leave us with more questions than answers when it comes to TXA in trauma, but it doesn’t seem to be the magic potion we all wanted it to be.

Source
The Impact of Pre-Hospital TXA on Mortality among Bleeding Trauma Patients: A Systematic Review and Meta-Analysis. J Trauma Acute Care Surg. 2021 Feb 17. doi: 10.1097/TA.0000000000003120. Epub ahead of print.



Read in browser »


Recent Articles:

Risk of EMS Transport Refusal After Naloxone
VA ECMO for Massive PE + Cardiac Arrest
COVID-19 Silent Myocarditis - COMPETE CMR
Ten Commandments of Emergency Medicine Revisited
Canadian TIA Score Beats ABCD2
 
Want credit for what you just read? Yes, please!
Through the joint providership of Hippo Education and JournalFeed, you can now get up to 27 AMA PRA Category 1 Credits™ per year for reading JournalFeed.
Get CME Credit
Share Share
Tweet Tweet
Forward Forward
Copyright © 2021 JournalFeed, All rights reserved.


Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list