Tranexamic Acid (TXA) Trial StudyInclusion Criteria Review

July 2015

Inclusion Criteria for Prehospital Providers

• Patients must meet trauma triage criteria related to anatomic, physiologic, and mechanism of injury as established by REMSA.• Refer to REMSA Policy 5301- Trauma Triage

Indicators and Destination

Pathophysiology of hemorrhagic shock

• As volume loss continues, O2 delivery and O2 consumption are mismatched. Anaerobic metabolism increases causing cell damage and eventual cell death.

Pathophysiology of Hemorrhagic Shock

• DO2crit – oxygen delivery

content available for circulation compared with VO2 (O2 consumption).

• Therapeutic goals: maintain circulating blood volume, reverse tissue hypoxia

Tranexamic Acid

- TXA can decrease the severity of the hemorrhage by preventing clot breakdown helps maintain circulating blood volume

- Given within the first 3 hours can decrease mortality from hemorrhage – time matters!

Inclusion Criteria forPrehospital Providers

• There are two types of patients who should receive prehospital TXA:

• Patient Type #1: An adult critical trauma patient with any sustained blunt or penetrating trauma within three (3) hours with signs and symptoms of hemorrhagic shock:

- With Systolic blood pressure of less than 90 mmHg at scene of injury, during ground medical transport, or on arrival to designated trauma centers.

Inclusion Criteria for Prehospital Providers cont’d

• Or Patient Type #2: • Adult critical trauma Patient with any sustained blunt or

penetrating injuries within three (3) hours with signs and symptoms of hemorrhagic shock who are considered to be “high risk” for hemorrhage:

- EBL > 500 mL in the field with HR > 120

- Bleeding uncontrolled by direct pressure or tourniquet

- Major amputation of any extremity above wrist or ankles

REMSA 5801

Don’t forget to document the armband number

The green armband is the tracking of the patients both prehospitaland hospital. Please document on the ePCR.

TXA Pearls of Wisdom

• Seconds count! Do not delay TXA administration, even if you are at the back door of the trauma center.• TXA administration may not happen immediately in the ER, delays

can quickly add up to 30 minutes or more!

• Follow the inclusion criteria! When in doubt, contact trauma base hospital.

• Record full blood pressures – systolic and diastolic to assess patient’s response to therapy and the degree of hemorrhagic shock.

TXA Pearls of Wisdom

• TXA is for hemorrhaging or at risk for hemorrhaging patients with blunt or penetrating trauma ONLY! (Isolated GI bleeds, nose bleeds, post-surgical bleeds and post-partum bleeds etc. are not included in this study)

• Remember to document pre-, during, and post- TXA administration vital signs, temperature and EBL• SBP and DBP need to be included throughout PCR.

• Describe patient situation in PCR and in trauma base report

Exclusion Criteria

• Any patient under 18 years of age.• Any patient with an active thromboembolic event (within

the last 24 hours), i.e., active stroke, myocardial infarction or pulmonary embolism.

• Any patient with a hypersensitivity or anaphylactic reaction to TXA.

• Any patient more than three (3) hours post injury.

Exclusion Criteria

• Traumatic arrest with greater than five (5) minutes of CPR without return of vital signs

• Penetrating cranial injury

• Traumatic brain injury with brain matter exposed

• Isolated drowning or hanging victims

• Documented cervical cord injury with motor deficit

TXA Administration

• Administer TXA 1 gm in 100 ml of NS via IV/IO over 10 minutes.

(Do not administer IVP. This will cause hypotension.)• Remember to flush the tubing

We appreciate our EMS providers and Trauma Centers

for participating in this study!!!

Thank you all for your cooperation!