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Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study

INTRODUCTION: The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to assess the safety and impact on patient mortality of tranexamic acid (TXA) administration in cases of trauma-induced hemorrhagic shock. The current study further aimed to assess the feasibility of prehospital...

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Autores principales: Neeki, Michael M., Dong, Fanglong, Toy, Jake, Vaezazizi, Reza, Powell, Joe, Jabourian, Nina, Jabourian, Alex, Wong, David, Vara, Richard, Seiler, Kathryn, Pennington, Troy W., Yoshida-McMath, Chris, Kissel, Shanna, Schulz-Costello, Katharine, Mistry, Jamish, Surrusco, Matthew S., O’Bosky, Karen R., Van Stralen, Daved, Ludi, Daniel, Sporer, Karl, Benson, Peter, Kwong, Eugene, Pitts, Richard, Culhane, John T., Borger, Rodney
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468073/
https://www.ncbi.nlm.nih.gov/pubmed/28611888
http://dx.doi.org/10.5811/westjem.2017.2.32044
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author Neeki, Michael M.
Dong, Fanglong
Toy, Jake
Vaezazizi, Reza
Powell, Joe
Jabourian, Nina
Jabourian, Alex
Wong, David
Vara, Richard
Seiler, Kathryn
Pennington, Troy W.
Powell, Joe
Yoshida-McMath, Chris
Kissel, Shanna
Schulz-Costello, Katharine
Mistry, Jamish
Surrusco, Matthew S.
O’Bosky, Karen R.
Van Stralen, Daved
Ludi, Daniel
Sporer, Karl
Benson, Peter
Kwong, Eugene
Pitts, Richard
Culhane, John T.
Borger, Rodney
author_facet Neeki, Michael M.
Dong, Fanglong
Toy, Jake
Vaezazizi, Reza
Powell, Joe
Jabourian, Nina
Jabourian, Alex
Wong, David
Vara, Richard
Seiler, Kathryn
Pennington, Troy W.
Powell, Joe
Yoshida-McMath, Chris
Kissel, Shanna
Schulz-Costello, Katharine
Mistry, Jamish
Surrusco, Matthew S.
O’Bosky, Karen R.
Van Stralen, Daved
Ludi, Daniel
Sporer, Karl
Benson, Peter
Kwong, Eugene
Pitts, Richard
Culhane, John T.
Borger, Rodney
author_sort Neeki, Michael M.
collection PubMed
description INTRODUCTION: The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to assess the safety and impact on patient mortality of tranexamic acid (TXA) administration in cases of trauma-induced hemorrhagic shock. The current study further aimed to assess the feasibility of prehospital TXA administration by paramedics within the framework of North American emergency medicine standards and protocols. METHODS: This is an ongoing multi-centered, prospective, observational cohort study with a retrospective chart-review comparison. Trauma patients identified in the prehospital setting with signs of hemorrhagic shock by first responders were administered one gram of TXA followed by an optional second one-gram dose upon arrival to the hospital, if the patient still met inclusion criteria. Patients administered TXA make up the prehospital intervention group. Control group patients met the same inclusion criteria as TXA candidates and were matched with the prehospital intervention patients based on mechanism of injury, injury severity score, and age. The primary outcomes were mortality, measured at 24 hours, 48 hours, and 28 days. Secondary outcomes measured included the total blood products transfused and any known adverse events associated with TXA administration. RESULTS: We included 128 patients in the prehospital intervention group and 125 in the control group. Although not statistically significant, the prehospital intervention group trended toward a lower 24-hour mortality rate (3.9% vs 7.2% for intervention and control, respectively, p=0.25), 48-hour mortality rate (6.3% vs 7.2% for intervention and control, respectively, p=0.76), and 28-day mortality rate (6.3% vs 10.4% for intervention and control, respectively, p=0.23). There was no significant difference observed in known adverse events associated with TXA administration in the prehospital intervention group and control group. A reduction in total blood product usage was observed following the administration of TXA (control: 6.95 units; intervention: 4.09 units; p=0.01). CONCLUSION: Preliminary evidence from the Cal-PAT study suggests that TXA administration may be safe in the prehospital setting with no significant change in adverse events observed and an associated decreased use of blood products in cases of trauma-induced hemorrhagic shock. Given the current sample size, a statistically significant decrease in mortality was not observed. Additionally, this study demonstrates that it may be feasible for paramedics to identify and safely administer TXA in the prehospital setting.
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spelling pubmed-54680732017-06-13 Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study Neeki, Michael M. Dong, Fanglong Toy, Jake Vaezazizi, Reza Powell, Joe Jabourian, Nina Jabourian, Alex Wong, David Vara, Richard Seiler, Kathryn Pennington, Troy W. Powell, Joe Yoshida-McMath, Chris Kissel, Shanna Schulz-Costello, Katharine Mistry, Jamish Surrusco, Matthew S. O’Bosky, Karen R. Van Stralen, Daved Ludi, Daniel Sporer, Karl Benson, Peter Kwong, Eugene Pitts, Richard Culhane, John T. Borger, Rodney West J Emerg Med Critical Care INTRODUCTION: The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to assess the safety and impact on patient mortality of tranexamic acid (TXA) administration in cases of trauma-induced hemorrhagic shock. The current study further aimed to assess the feasibility of prehospital TXA administration by paramedics within the framework of North American emergency medicine standards and protocols. METHODS: This is an ongoing multi-centered, prospective, observational cohort study with a retrospective chart-review comparison. Trauma patients identified in the prehospital setting with signs of hemorrhagic shock by first responders were administered one gram of TXA followed by an optional second one-gram dose upon arrival to the hospital, if the patient still met inclusion criteria. Patients administered TXA make up the prehospital intervention group. Control group patients met the same inclusion criteria as TXA candidates and were matched with the prehospital intervention patients based on mechanism of injury, injury severity score, and age. The primary outcomes were mortality, measured at 24 hours, 48 hours, and 28 days. Secondary outcomes measured included the total blood products transfused and any known adverse events associated with TXA administration. RESULTS: We included 128 patients in the prehospital intervention group and 125 in the control group. Although not statistically significant, the prehospital intervention group trended toward a lower 24-hour mortality rate (3.9% vs 7.2% for intervention and control, respectively, p=0.25), 48-hour mortality rate (6.3% vs 7.2% for intervention and control, respectively, p=0.76), and 28-day mortality rate (6.3% vs 10.4% for intervention and control, respectively, p=0.23). There was no significant difference observed in known adverse events associated with TXA administration in the prehospital intervention group and control group. A reduction in total blood product usage was observed following the administration of TXA (control: 6.95 units; intervention: 4.09 units; p=0.01). CONCLUSION: Preliminary evidence from the Cal-PAT study suggests that TXA administration may be safe in the prehospital setting with no significant change in adverse events observed and an associated decreased use of blood products in cases of trauma-induced hemorrhagic shock. Given the current sample size, a statistically significant decrease in mortality was not observed. Additionally, this study demonstrates that it may be feasible for paramedics to identify and safely administer TXA in the prehospital setting. Department of Emergency Medicine, University of California, Irvine School of Medicine 2017-06 2017-04-19 /pmc/articles/PMC5468073/ /pubmed/28611888 http://dx.doi.org/10.5811/westjem.2017.2.32044 Text en Copyright: © 2017 Neeki et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Critical Care
Neeki, Michael M.
Dong, Fanglong
Toy, Jake
Vaezazizi, Reza
Powell, Joe
Jabourian, Nina
Jabourian, Alex
Wong, David
Vara, Richard
Seiler, Kathryn
Pennington, Troy W.
Powell, Joe
Yoshida-McMath, Chris
Kissel, Shanna
Schulz-Costello, Katharine
Mistry, Jamish
Surrusco, Matthew S.
O’Bosky, Karen R.
Van Stralen, Daved
Ludi, Daniel
Sporer, Karl
Benson, Peter
Kwong, Eugene
Pitts, Richard
Culhane, John T.
Borger, Rodney
Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study
title Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study
title_full Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study
title_fullStr Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study
title_full_unstemmed Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study
title_short Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study
title_sort efficacy and safety of tranexamic acid in prehospital traumatic hemorrhagic shock: outcomes of the cal-pat study
topic Critical Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468073/
https://www.ncbi.nlm.nih.gov/pubmed/28611888
http://dx.doi.org/10.5811/westjem.2017.2.32044
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