Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study.
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TLDR
The use of TXA with blood component-based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion.Abstract:
Objectives To characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality. Design Retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (≥10 units of packed red blood cells) was also examined. Univariate and multivariate regression analyses were used to identify parameters associated with survival. Kaplan-Meier life tables were used to report survival. Setting A Role 3 Echelon surgical hospital in southern Afghanistan. Patients A total of 896 consecutive admissions with combat injury, of which 293 received TXA, were identified from prospectively collected UK and US trauma registries. Main Outcome Measures Mortality at 24 hours, 48 hours, and 30 days as well as the influence of TXA administration on postoperative coagulopathy and the rate of thromboembolic complications. Results The TXA group had lower unadjusted mortality than the no-TXA group (17.4% vs 23.9%, respectively; P = .03) despite being more severely injured (mean [SD] Injury Severity Score, 25.2 [16.6] vs 22.5 [18.5], respectively; P Conclusions The use of TXA with blood component–based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion. Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.read more
Citations
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Death on the battlefield (2001-2011): Implications for the future of combat casualty care
Brian J. Eastridge,Robert L. Mabry,Peter Seguin,Joyce Cantrell,Terrill Tops,Paul Uribe,Olga Mallett,Tamara Zubko,Lynne Oetjen-Gerdes,Todd E. Rasmussen,Frank K. Butler,Russ S Kotwal,John B. Holcomb,Charles E. Wade,Howard R. Champion,Mimi Lawnick,Leon E. Moores,Lorne H. Blackbourne +17 more
TL;DR: To significantly impact the outcome of combat casualties with PS injury, strategies must be developed to mitigate hemorrhage and optimize airway management or reduce the time interval between the battlefield point of injury and surgical intervention.
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The systemic immune response to trauma: an overview of pathophysiology and treatment.
Janet M. Lord,Mark J. Midwinter,Yen-Fu Chen,Yen-Fu Chen,Antonio Belli,Karim Brohi,Elizabeth J. Kovacs,Leo Koenderman,Paul Kubes,Richard J. Lilford,Richard J. Lilford +10 more
TL;DR: The biological mechanisms and clinical implications of the cascade of events caused by large-scale trauma that leads to multiorgan failure and death, despite the stemming of blood loss are examined.
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A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation
Megan Brenner,Laura J. Moore,Joseph J. DuBose,George H. Tyson,Michelle K. McNutt,Rondel Albarado,John B. Holcomb,Thomas M. Scalea,Todd E. Rasmussen +8 more
TL;DR: Implementation of REBOA is a feasible and effective means of proactive aortic control for patients in end-stage shock from blunt and penetrating mechanisms and can be performed by trauma and acute care surgeons who have benefited from instruction on a limited endovascular skill set.
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Association of Prehospital Blood Product Transfusion During Medical Evacuation of Combat Casualties in Afghanistan With Acute and 30-Day Survival
Stacy Shackelford,Deborah J. del Junco,Nicole Powell-Dunford,Edward L. Mazuchowski,Jeffrey T. Howard,Russ S Kotwal,Jennifer M. Gurney,Frank K. Butler,Kirby R. Gross,Zsolt T. Stockinger +9 more
TL;DR: Among medically evacuated US military combat causalities in Afghanistan, blood product transfusion prehospital or within minutes of injury was associated with greater 24-hour and 30-day survival than delayed transfusion or no transfusion.
Journal ArticleDOI
Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma.
Jeremy W. Cannon,Mansoor Khan,Ali S. Raja,Mitchell J. Cohen,John J. Como,Bryan A. Cotton,Joseph J. DuBose,Erin E. Fox,Kenji Inaba,Carlos J. Rodriguez,John B. Holcomb,Juan Duchesne +11 more
TL;DR: This guideline recommends the use of a MT/DCR protocol in hospitals that manage such patients and recommends that the protocol target a high ratio of PLAS and PLT to RBC, and conditionally recommend the in-hospital use of TXA early in the management of severely injured bleeding patients.
References
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Journal ArticleDOI
The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care
TL;DR: Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma.
Journal ArticleDOI
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
TL;DR: Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study, and should be considered for use in bleed trauma patients.
Journal ArticleDOI
A revision of the Trauma Score.
Howard R. Champion,William J. Sacco,Wayne S. Copes,Donald S. Gann,Thomas A. Gennarelli,Maureen E. Flanagan +5 more
TL;DR: T-RTS, the sum of coded values of GCS, SBP, and RR, demonstrated increased sensitivity and some loss in specificity when compared with a triage criterion based on TS and GCS values, and RTS demonstrated substantially improved reliability in outcome predictions compared to the TS.
Journal ArticleDOI
The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital
Matthew A. Borgman,Philip C. Spinella,Jeremy G. Perkins,Kurt W. Grathwohl,Thomas Repine,Alec C. Beekley,James A. Sebesta,Donald H. Jenkins,Charles E. Wade,John B. Holcomb +9 more
TL;DR: In patients with combat-related trauma requiring massive transfusion, a high 1:1.4 plasma to RBC ratio is independently associated with improved survival to hospital discharge, primarily by decreasing death from hemorrhage.
Journal ArticleDOI
The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial.
Ian Roberts,Haleema Shakur,AO Afolabi,Karim Brohi,Timothy J Coats,Yashbir Dewan,Satoshi Gando,Gordon H. Guyatt,Beverley J. Hunt,Carlos Morales,Pablo Perel,David Prieto-Merino,Tom Woolley +12 more
TL;DR: Strong evidence is recorded that tranexamic acid should be given as early as possible to bleeding trauma patients with significant haemorrhage, and for trauma patients admitted late after injury, tranExamic acid is less effective and could be harmful.
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