Case Series on 2g Tranexamic Acid Flush From the 75th Ranger Regiment Casualty Database.

Area of Science:

• Trauma resuscitation
• Emergency medicine
• Military medicine

Background:

• Early tranexamic acid (TXA) administration improves mortality in critically injured patients.
• Current Tactical Combat Casualty Care (TCCC) guidelines recommend a slow TXA infusion (1g over 10 min, then 1g over 8 hours) to mitigate side effects.
• This slow infusion protocol is challenging in tactical environments, and side effect concerns are based on non-military populations.

Purpose of the Study:

• To evaluate the safety and feasibility of a novel 2g intravenous or intraosseous (IV/IO) TXA flush protocol in critically injured warfighters.
• To assess the incidence of adverse events, specifically hypotension, seizures, and anaphylaxis, following the rapid TXA administration.

Main Methods:

• The 75th Ranger Regiment implemented a 2g IV/IO TXA flush protocol for resuscitation.
• Six cases utilizing this protocol were reviewed through after-action reports (AARs).
• Data collection focused on the occurrence of post-TXA hypotension, seizures, and anaphylaxis.

Main Results:

• No incidences of post-TXA hypotension were reported in the six cases.
• No cases of seizures or anaphylaxis were observed following the 2g IV/IO TXA flush.
• The rapid infusion protocol was successfully implemented in the tactical care setting.

Conclusions:

• The 2g IV/IO TXA flush protocol appears safe and feasible for use in critically injured warfighters.
• This novel protocol may offer a more practical alternative to the current TCCC recommendations.
• Further research in larger studies is warranted to confirm the safety and efficacy of this rapid TXA administration method.