Flight-Crew Administration Speeds Time to Tranexamic Acid: FAST TXA Study

Tranexamic acid (TXA) is a standard therapy for the early treatment of life-threatening traumatic hemorrhage. Multiple studies suggest a benefit to earlier TXA, and meta-analysis calculates that each 15-minute time savings achieved by prehospital TXA improves mortality 10%. In trauma patients for whom helicopter emergency medical services (HEMS) initiated prehospital TXA, this study's primary aim was to calculate the minutes' time savings achieved compared with hypothetical TXA initiation at trauma centers. A secondary study aim was to evaluate whether there was geographic variation in the degree to which HEMS-initiated TXA expedited the initiation of the TXA.

Four years of data (2021-2024) were queried using the medical records database of a nationwide HEMS organization. Eligible cases were injured patients who received TXA initiated by HEMS flight crews in the prehospital setting. Variables assessed included patient age, sex, transport year, state/US Census Bureau region, time of TXA initiation, and time of hospital arrival.

The study assessed 7,188 prehospital HEMS TXA initiations and found that flight-crew commencement of TXA therapy saved a median of 22 minutes overall and 25 minutes for pediatric patients. In all 4 regions of the United States, HEMS initiation of TXA saved at least 15 minutes; inter-regional variation in the degree to which HEMS initiation of TXA saved time was largely explained by variations in overall prehospital time.

In the study dataset, HEMS was associated with significantly faster time to TXA, and despite regional variation in the degree of time savings, HEMS initiation of TXA saved at least 15 minutes in all 4 major US regions. Application of the metric of 10% survival increment per 15-minute expedited TXA initiation resulted in an estimate of mortality improvement of 14.7% overall and 16.7% for pediatric patients.