• Emerg Med J · Jul 2019

    Prehospital tranexamic acid shortens the interval to administration by half in Major Trauma Networks: a service evaluation.

    • Marsden Max E R MER http://orcid.org/0000-0002-7147-6861 Academic Departments of Military Surgery, Trauma and Anaesthesia, Royal Centre for Defence Me, Andrea Rossetto, Charles A B Duffield, Thomas G D Woolley, William P Buxton, Sarah Steynberg, Rahul Bagga, and Tai Nigel R M NRM Academic Departments of Military Surgery, Trauma and Anaesthesia, Royal Centre for Defence Medicine, Birmingham, UK. .
    • Academic Departments of Military Surgery, Trauma and Anaesthesia, Royal Centre for Defence Medicine, Birmingham, UK.
    • Emerg Med J. 2019 Jul 1; 36 (7): 395-400.

    IntroductionTranexamic acid (TXA) reduces bleeding and mortality. Recent trials have demonstrated improved survival with shorter intervals to TXA administration. The aims of this service evaluation were to assess the interval from injury to TXA administration and describe the characteristics of patients who received TXA pre-hospital and in-hospital.MethodsWe reviewed Trauma and Audit Research Network records and local trauma registries to identify patients of any age that received TXA at all London Major Trauma Centres and Queen's Medical Centre, Nottingham, during 2017. We used the 2016 NICE Guidelines (NG39) which state that TXA should be given within 3 hours of injury.ResultsWe identified 1018 patients who received TXA, of whom 661 (65%) had sufficient data to assess the time from injury to TXA administration. The median interval was 74 min (IQR: 47-116). 92% of patients received TXA within 3 hours from injury, and 59% within 1 hour. Half of the patients (54%) received prehospital TXA. The median time to TXA administration when given prehospital was 51 min (IQR: 39-72), and 112 min (IQR: 84-160) if given in-hospital (p<0.001). In-hospital TXA patients had less haemodynamic derangement and lower base deficit on admission compared with patients given prehospital TXA.ConclusionPrehospital administration of TXA is associated with a shorter interval from injury to drug delivery. Identifying a proportion of patients at risk of haemorrhage remains a challenge. However, further reinforcement is needed to empower pre-hospital clinicians to administer TXA to trauma patients without overt signs of shock.© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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