TXA for HEMS patients with suspected haemorrhage

Abstract

Background: Tranexamic Acid (TXA) has been shown by the CRASH-2 study to reduce the risk of death by bleeding. This evaluation assesses the use of TXA by the Great North Air Ambulance (GNAAS), and considers the individual patient outcomes in hospital, including the need for blood products and venous thromboembolism (VTE) rate. Methods: A service evaluation was performed with the analysis of patient outcome by the review of patient report forms over a 1-year period. Patients who received pre-hospital TXA were identified and further analysis of their outcomes was performed at the two receiving local major trauma centres. Results: 106 patients received pre-hospital TXA, all within 3 hours. The majority (73%, n=77) had been involved in a road traffic collision. Thirty per cent (n=32) of patients also received a pre-hospital blood transfusion; 73% (n=58) were subsequently shown to have an injury severity score (ISS) ≥15, which traditionally defines major trauma. Six (6.3%) patients were later found to have a VTE (five pulmonary embolism and one deep-vein thrombosis) within 1 month of injury, although no patients died of VTE. Almost half of the patients received an in-hospital transfusion 45% (n= 45). Conclusion: TXA is a life-saving drug in the bleeding trauma patient, and within this study population, TXA was administered promptly and appropriately. A VTE incidence of 6.3% is in line with other literature, and there were no recorded deaths from VTE. TXA is available to pre-hospital clinicians across the UK, where the author believes its use should be encouraged.