Prehospital Tranexamic Acid Administration During Aeromedical Transport After Injury

Area of Science:

• Trauma care
• Emergency medicine
• Pharmacology

Background:

• Tranexamic acid (TXA) reduces mortality in traumatic hemorrhage, particularly when administered early.
• Early TXA administration is crucial for optimal outcomes in trauma patients.

Purpose of the Study:

• To evaluate the efficacy and safety of extending TXA administration protocols into the prehospital aeromedical setting.
• To compare outcomes and safety profiles of prehospital TXA versus emergency department (ED) TXA.

Main Methods:

• Retrospective analysis of 116 trauma patients who received TXA via prehospital aeromedical transport or in the ED.
• Inclusion criteria: adult trauma patients with high-risk mechanisms and concern for severe hemorrhage.
• Data collected: demographics, vital signs, lab values, blood administration, mortality, and complications.

Main Results:

• No significant difference in survival rates or complication rates between prehospital and ED TXA administration.
• Prehospital TXA patients were more likely to have sustained blunt injury.
• Higher rates of venous thromboembolic events observed in TXA recipients (8.1% prehospital, 18.5% ED) compared to the overall trauma population (2.1%).

Conclusions:

• Prehospital TXA via aeromedical transport did not enhance survival compared to ED administration.
• TXA treatment is associated with an increased risk of venous thromboembolic events.
• Refinement of prehospital TXA protocols is needed to better identify patients with severe hemorrhagic shock or traumatic brain injury.