Take Home: TXA works in an established trauma system.
– Annals of Surgery 2015
Study: Prospective Observational Cohort done in England of patients while their trauma system initiated use of TXA therapy in their Massive Transfusion Protocols
Patients: Trauma patients >15 yo with ISS >15 (sick):
- SBP <90
- Poor response to Fluids bolus AND
- Suspected Hemorrhage
They also gathered information on “shock” defined as an ABG showing a base deficit of > 6 mEq/L.
Intervention: “CODE RED” was called, and treated with 1g over 10 min, and infusion of 1g of TXA
Comparison: Patients who did NOT get TXA – this group was very different than the TXA group.
Outcomes: Mortality, Multi-organ system failure, Infection, VTE, and Stroke/MI amongst other outcomes.
Results: 160 patients got TXA, 225 did not. TXA patients were much sicker, which made analysis difficult.
Multivariate analysis showed: TXA improved Mortality and Multiorgan Failure in Hypotensive patients only, with no effect in normotensive patients.
Conclusion: This is a smaller study that seems to show effect mostly in patients with shock, though how they got there and their measurement of shock as a base excess is a bit unusual.