Abstract
Objectives
This study aimed to characterize the clinical utilization of tranexamic acid (TXA) by paramedics in British Columbia (BC) for acute major trauma and to quantify the percentage of patients who received TXA among those who met the indications for administration.
Methods
A quality assurance review of eligible trauma patients across the province was performed using a convenience sample. Trauma patients between April 1, 2016 and March 31, 2017 with suspected or actual hemorrhage were selected if they met inclusion criteria (systolic blood pressure < 90 mm Hg ± heart rate > 120 beats per minute) and exclusion criteria (age < 16 years, injuries exclusively to the extremities).
Results
35 of the 100 eligible patients assessed in this review received a dose of TXA from paramedics. All 35 of the patients received TXA within 180 min of injury regardless of their original location of injury in BC (mean: 50 min; range: 15–140 min).
Conclusions
35% of eligible patients identified in this study received TXA, which is an improvement over rates cited by previous Canadian literature. With further education opportunities for paramedics in BC and other EMS systems, there is potential to continue improving pre-hospital TXA administration rates.
Résumé
Objectifs
Cette étude visait à caractériser l’utilisation clinique de l’acide tranexamique (TXA) par les ambulanciers paramédicaux de la Colombie-Britannique pour les traumatismes aigus majeurs et à quantifier le pourcentage de patients qui ont reçu du TXA parmi ceux qui répondaient aux indications d’administration.
Méthodes
Un examen de l'assurance qualité des patients traumatisés admissibles dans toute la province a été effectué à l'aide d'un échantillon de commodité. Les patients traumatisés entre le 1er avril 2016 et le 31 mars 2017 présentant une hémorragie suspectée ou réelle ont été sélectionnés s'ils répondaient aux critères d'inclusion (pression artérielle systolique < 90 mm Hg ± fréquence cardiaque > 120 battements par minute) et aux critères d'exclusion (âge < 16 ans, blessures exclusivement aux extrémités).
Résultats
35 des 100 patients admissibles évalués dans le cadre de cet examen ont reçu une dose de TXA des ambulanciers paramédicaux. Les 35 patients ont tous reçu du TXA dans les 180 min suivant la blessure, quel que soit le lieu de leur blessure initiale en Colombie-Britannique (moyenne: 50 min; intervalle: 15 à 140 min).
Conclusions
35% des patients admissibles identifiés dans le cadre de cette étude ont reçu du TXA, ce qui représente une amélioration par rapport aux taux cités dans les publications canadiennes précédentes. Grâce aux possibilités de formation continue pour les ambulanciers en Colombie-Britannique et dans d'autres systèmes d’Aide médicale urgente (AMU), il est possible de continuer à améliorer les taux d'administration de la TXA en milieu préhospitalier.
References
Trauma Management-Intervention Guidelines [Internet]. BCEHS Handbook. 2020 [cited 31 August 2020]. Available from: https://umbraco.bcas.ca/treatment-guidelines/adult-guidelines/major-trauma/trauma-management/trauma-management-intervention-guidelines/
Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, With CRASH-2 trial collaborators, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23–32.
Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, With CRASH-2 trial collaborators, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096-1101.e2.
Morrison J, Dubose J, Rasmussen T, Midwinter M. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012;147(2):113.
The CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet. 2019;394:1713–23.
Tallon JM. Trauma systems and emergency medical services: the missing link for tranexamic acid utilization in major trauma. CJEM. 2018;20(2):167–9.
El-Menyar A, Sathian B, Asim M, Latifi R, Al-Thani H. Efficacy of prehospital administration of tranexamic acid in trauma patients: a meta-analysis of the randomized controlled trials. Am J Emerg Med. 2018;36:1079–87.
Ng M, Perrott J, Burgess S. Evaluation of tranexamic acid in trauma patients: a retrospective quantitative analysis. Am J Emerg Med. 2018;37:444–9.
Ghawnni A, Coates A, Owen J. Compliance of tranexamic acid administration to trauma patients at a level-one trauma centre. CJEM. 2017;20(02):216–21.
Acknowledgements
The authors would like to acknowledge Julie Wei for her assistance with this study.
Funding
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
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Wong, D., Su, G., Mabasa, V.H. et al. Assessing the clinical utilization of tranexamic acid by paramedics for patients with major trauma (ACUTE). Can J Emerg Med 23, 219–222 (2021). https://doi.org/10.1007/s43678-020-00040-4
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DOI: https://doi.org/10.1007/s43678-020-00040-4