Outcomes from Tranexamic Acid (TXA) in Traumatic Intracranial and Torso Hemorrhage: A Prospective Cohort Study in a High Trauma, Austere, Prolonged Care Setting
Abstract
Background: Hemorrhage is a leading cause of early and preventable deaths among injured patients, with most deaths occurring within the first 24 hours after injury. Further, intracranial bleeding contributes up to one-fifth of potentially preventable deaths in U.S. military personnel who arrive at a treatment facility. Further, the concurrence of torso and intracranial bleeding carries a two-fold increase in mortality. Treatment is incredibly challenging, as hemorrhage in the torso and cranium cannot be controlled by standard methods (i.e., applying pressure) and often requires operative interventions. Additionally, uncontrolled hemorrhage is exacerbated by other post-injury physiologic complications, such as acidosis, coagulopathy, and multi-organ failure. This application will address the Focus Area of: Solutions to enhance combat care delivery throughout the far-forward environment. This proposal is also highly relevant to the following Area of Encouragement: Solutions to Enhance Combat Care Delivery Throughout the Far-Forward Environment: Tactical Combat Casualty Care (TCCC) wherein we will specifically focus on: tools and techniques to optimize and sustain (more than 12 hours) resuscitation for hemorrhagic shock injuries. Objectives and Reasoning: The objective of this research is to define how tranexamic acid (TXA) use in a real-world, military-relevant, prolonged care setting impacts morbidity and mortality outcomes in polytrauma (head and torso hemorrhage) patients. Research to date has focused on the benefits of using TXA to reduce blood loss in either head or torso bleeding, mostly in clinical trials. Findings have mostly been promising, with a few studies demonstrating no benefit of TXA. In controlled studies, TXA helps manage both truncal and intracranial hemorrhage by preventing blood clot breakdown. Within multi-domain and combat operations, military medical personnel are expected to take care of an overwhelming volume of casualties in the far-forward care environment for prolonged periods as a result of more effective enemy weaponry (e.g., mortars, artillery, etc.). Interventions that are easy to administer and clinically effective need to be developed and validated. TXA is one such promising intervention to optimally treat life-threatening injuries. The Joint Trauma System clinical practice guidelines and the Committee on Tactical Combat Casualty Care (CoTCCC) have outlined and encouraged a role for TXA, both in damage control resuscitation in prolonged field care to mitigate hemorrhagic shock and in casualties with signs and symptoms of intracranial bleeding. Problem Addressed: Despite TXA’s implementation in military and civilian clinical settings, there remain three critical knowledge gaps regarding TXA outcomes: (1) Most TXA studies have focused on either torso hemorrhage or intracranial bleeding, but very few studies have deliberately assessed patients with both intracranial and torso bleeding. More evidence is needed to understand how TXA performs in the polytrauma population. (2) The preponderance of military and civilian TXA studies have focused on mortality, yet morbidity (e.g., organ failure, neurologic outcomes) remains poorly characterized. (3) Evidence is needed to specifically understand the implications of receiving TXA in a prolonged care setting – the majority of prior studies have assessed TXA in doctrinal U.S. military situations or in urban U.S. locations with short times from injury to definitive surgical care. Our proposed study will provide evidence to help fill each of these gaps. Research Aims: The purpose of this research is to compare the morbidity and mortality of polytrauma (head and torso bleeding) patients who receive TXA (administered within the first 24 hours post-injury) versus comparably injured patients who do not receive TXA in a prolonged care setting. We will also provide data to help identify the injury and physiologic profiles suitable for TXA (incl
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210883
Entities
People
- Nee-Kofi Mould-Millman
Organizations
- United States Army
- University of Colorado Denver