Trauma can occur from a variety of sources such as car accidents, natural disasters, and violence. Many of these injuries can result in excessive bleeding known as hemorrhage. In some cases hemorrhage following a traumatic injury can lead to death. There are limited resources to stop bleeding at an accident scene or during emergency transport. New medications, however, may be able to slow excessive bleeding by improving the body’s ability to clot.
One particular drug, Tranexamic Acid (TXA), has been tested internationally and in areas of combat and shown to improve survivability from bleeding. Arrowhead Regional Medical Center (ARMC) and Loma Linda University Medical Center (LLUMC) physicians in conjunction with Inland Counties Emergency Medical Agency (ICEMA) and several fire departments initiated a research study to evaluate whether TXA could improve patient outcomes if given prior to arrival at the hospital.
The Emergency Medical Services (EMS) involved in this study were ICEMA, Riverside County EMS Agency, and Alameda County EMS agencies. All trauma centers in San Bernardino, Riverside, and Alameda counties participated in the trial. The largest contribution of patients was from ICEMA and Riverside County EMS Agency. More than 1,500 paramedics were trained in the prehospital setting for this study.
Nearly 30 EMS agencies came together at the state level to work on this study, which is one of the largest North American studies of its kind, according to the research team. The study led to the approval of TXA by the California EMS Authority to be used in the prehospital trauma setting.
“This study brought many statewide agencies together and we are hoping to continue our cooperation to improve trauma care for the state of California,” said Michael M. Neeki, D.O., M.S., Associate Clinical Professor of Emergency Medicine at ARMC, and primary investigator for this study.
This study included trauma cases from March 2015 through July 2017 treated with TXA in the field and assessed clinical outcomes recorded at the responding hospital. Patients who were provided TXA prior to hospital arrival were matched to patients who were seen within five years prior and prior to the use of TXA. This study set out to determine whether TXA administered by paramedics could reduce the risk of death and other clinical outcomes related to hemorrhage.
A total of 724 patients were included, with 362 patients treated with TXA and 362 patients not treated with TXA. The study noted reduced risk of death 28 days following the traumatic injury particularly among patients that suffered the most severe injuries. Additionally, less blood products were needed to compensate for blood loss following prehospital use of TXA. Furthermore, adverse events related to TXA’s ability to increase clotting were not identified with TXA use in the study.
The results of this study found that TXA use for excessive bleeding following trauma was beneficial and improved patient survival. See complete paper at this link: https://escholarship.org/uc/item/9f99j268
ARMC is a 456-bed university-affiliated teaching hospital licensed by the State of California Department of Public Health, operated by the County of San Bernardino, and governed by the Board of Supervisors. The hospital, located on a 70-acre campus in Colton, California, operates a regional burn center, level II trauma center, primary stroke center, a behavioral health center, five primary care centers, and provides more than 40 outpatient specialty care services. ARMC is helping to achieve the Countywide Vision by addressing the community’s wellness and educational needs. For more information about ARMC visit www.arrowheadmedcenter.org. Follow ARMC on Twitter at @ArrowheadRMC for important announcements and updates, and on Facebook at www.facebook.com/arrowheadregional.