Prehospital Use of Tranexamic Acid for Hemorrhagic Shock in Primary and Secondary Air Medical Evacuation

• Published in: Air medical journal 2013-09, Vol.32 (5), p.289-292
• Main Authors: Vu, Erik Nelson, CCP, MD, FRCPC, DAvMed, Schlamp, Rob S., CCP, Wand, Robert T., CCP, Kleine-Deters, Geoff A., CCP, RN, Vu, Mark P., MD, FRCPC, Tallon, John M., MD, MSc, FRCPC
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Air Ambulances; Antifibrinolytic Agents - therapeutic use; Clinical Protocols; Emergency; Emergency Medical Services - methods; Female; Health administration; Humans; Internal Medicine; Male; Middle Aged; Shock, Hemorrhagic - drug therapy; Tranexamic Acid - therapeutic use; Treatment Outcome; Young Adult
• ISSN: 1067-991X; 1532-6497
• DOI: 10.1016/j.amj.2013.05.001

Abstract Introduction Major hemorrhage remains a leading cause of death in both military and civilian trauma. We report the use of tranexamic acid (TXA) as part of a trauma exanguination/massive transfusion protocol in the management of hemorrhagic shock in a civilian primary and secondary air medical evacuation (AME) helicopter EMS program. Methods TXA was introduced into our CCP flight paramedic program in June 2011. Indications for use include age > 16 years, major trauma (defined a priori based on mechanism of injury or findings on primary survey), and heart rate (HR) > 110 beats per minute (bpm) or systolic blood pressure (SBP) < 90 mmHg. Our protocol, which includes 24-hour online medical oversight, emphasizes rapid initiation of transport, permissive hypotension in select patients, early use of blood products (secondary AME only), and infusion of TXA while en route to a major trauma center. Results Over a 4-month period, our CCP flight crews used TXA a total of 13 times. Patients had an average HR of 111 bpm [95% CI 90.71–131.90], SBP of 91 mmHg [95% CI 64.48–118.60], and Glascow Coma Score of 7 [95% CI 4.65–9.96]. For primary AME, average response time was 33 minutes [95% CI 19.03–47.72], scene time 22 minutes [95% CI 20.23–24.27], and time to TXA administration 32 minutes [95% CI 25.76–38.99] from first patient contact. There were no reported complications with the administration of TXA in any patient. Conclusion We report the successful integration of TXA into a primary and secondary AME program in the setting of major trauma with confirmed or suspected hemorrhagic shock. Further studies are needed to assess the effect of such a protocol in this patient population.