Mortality and Organ Failure Evidence to Guide Tranexamic Acid and Blood Product Resuscitation in Austere, Prolonged Care Settings
Abstract
Overview: This study focuses on the Peer Reviewed Medical Research Program (PRMRP) fiscal year 2022 (FY22) Topic Area of Trauma, within the Portfolio of Hemorrhage. Our application is intended to generate evidence to advance the U.S. military’s Strategic Goal to Evaluate the effects of current combat blood product transfusion guidelines on immunological status and clinical outcomes. Hemorrhage is the loss of blood from inside or outside the body. In injured military and civilian persons, hemorrhage is a leading cause of early and preventable deaths, occurring primarily within in the first few hours after a person sustains an injury. For example, among previously injured U.S. military personnel, over 90% of deaths occurred within 4 hours of injury, indicating that effective treatments need to be delivered very quickly. Survivors of major trauma often experience protracted morbidity, in part due to organ failure. Impaired functioning of one or more organs (called organ failure) has been found in 29% of all trauma patients, and multiple organ failure (MOF) is responsible for a large proportion of the health care resources associated with acute trauma care. Studies have shown mortality benefits of two drugs that help save patients who are bleeding out. One is Tranexamic acid (TXA), which is a medication that helps the body form clots to reduce bleeding. The second is blood transfusion, where whole blood or its components is administered intravenously into a patient to restore lost blood and important chemicals. Both of these therapeutics are actively used in military and civilian trauma care, but there are some gaps in knowledge. Specifically, much of the prior studies on TXA and blood were conducted in high income settings where patients have rapid access to care. However, this is not the case in rural civilian environments and in the future U.S. battlespace in which we anticipate a high volume of casualties and prolonged times to evacuation. Hence, this project is specifically intended to advance the PRMRP FY22 Strategic Goal via evaluating the patient outcomes of TXA and blood, as used in current U.S. military transfusion guidelines. Critical Problem to be Addressed: We recognize that both TXA and blood have been the standard of care in the U.S. military casualty care, and this application is not intended to provide routine data to show that each drug, individually, is life-saving in trauma care. Instead, this application seeks to innovatively fill several scientific and operational gaps relevant to TXA and blood resuscitation in prolonged critical injury: 1. What is the mortality benefit from administering both TXA and Blood? Very few studies have looked at this, even in non-prolonged care. 2. What is the impact of administering TXA and/or blood on multiple and individual organ failure? Few studies have provided data on how blood and TXA affect organ failure in trauma. 3. Last, and most importantly, we innovatively propose to answer both questions above in prolonged care scenarios. Impact: This study seeks to evaluate mortality and organ failure as outcomes among four patient groups who receive: only TXA, only blood, TXA and blood, and neither. Our research will inform current and future guidelines on TXA administration and blood transfusions as it pertains to prolonged casualty care in battlespaces and in trauma care among civilians. The ultimate goal of this work is to generate data to better understand how to most effectively resuscitate critically injured patients to help save their lives and to reduce their long-term disability by minimizing rates of organ failure.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252311025
Entities
People
- Nee-Kofi Mould-Millman
Organizations
- United States Army
- University of Colorado Denver