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Castro-Delgado R, Garijo-Gonzalo G, Cuartas-Alvarez T. Tranexamic acid needs to be implemented in mass casualty incident protocols. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02517-8. [PMID: 38801465 DOI: 10.1007/s00068-024-02517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/30/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Rafael Castro-Delgado
- Faculty of Medicine and Health Sciences, Department of Medicine, University of Oviedo, Julián Clavería, 6, 33006, Oviedo, Spain.
- Health Research Institute of the Principality of Asturias (Research Group On Prehospital Care and Disasters, GIAPREDE), Health Service of the Principality of Asturias (SAMU-Asturias), Oviedo, Spain.
- RINVEMER-SEMES (Research Network On Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain.
| | - Gracia Garijo-Gonzalo
- RINVEMER-SEMES (Research Network On Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain
- Emergencias Osakidetza. Vasc Country, Madrid, Spain
| | - Tatiana Cuartas-Alvarez
- Health Research Institute of the Principality of Asturias (Research Group On Prehospital Care and Disasters, GIAPREDE), Health Service of the Principality of Asturias (SAMU-Asturias), Oviedo, Spain
- RINVEMER-SEMES (Research Network On Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain
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Gauss T, de Jongh M, Maegele M, Cole E, Bouzat P. Trauma systems in high socioeconomic index countries in 2050. Crit Care 2024; 28:84. [PMID: 38493142 PMCID: PMC10943799 DOI: 10.1186/s13054-024-04863-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible epidemiological trajectories. A second section exposes existing governance and funding challenges, how these can be met, and the need to incorporate data and information science into a learning and adaptive trauma system. The last section suggests an international harmonization of trauma education to improve care standards, optimize immediate and long-term patient needs and enhance disaster preparedness and crisis resilience. By demonstrating their capacity for adaptation, trauma systems can play a leading role in the transformation of care systems to tackle future health challenges.
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Affiliation(s)
- Tobias Gauss
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France.
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France.
| | - Mariska de Jongh
- Network Emergency Care Brabant (NAZB), ETZ Hospital, Tilburg, The Netherlands
| | - Marc Maegele
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University Witten-Herdecke, Cologne, Germany
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Pierre Bouzat
- Division Anesthesia and Critical Care, University Hospital Grenoble Alpes, Grenoble, France
- Grenoble Institute for Neurosciences, Inserm, U1216, Grenoble Alpes University, Grenoble, France
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Hossain N, Kaur V, Mahran M, Quddus A, Mukhopadhyay S, Shah A, Agrawal S. Intra-operative Tranexamic Acid Administration Significantly Decreases Incidence of Postoperative Bleeding Without Increasing Venous Thromboembolism Risk After Laparoscopic Sleeve Gastrectomy: a Retrospective Cohort Study of Over 400 Patients. Obes Surg 2024; 34:396-401. [PMID: 38168716 DOI: 10.1007/s11695-023-07021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND There is evidence that tranexamic acid (TXA) reduces surgical bleeding and is widely used in trauma, obstetrics and other specialties. This practice is less well-established in laparoscopic sleeve gastrectomy (LSG) due to concerns surrounding venous thromboembolism (VTE); equally postoperative bleeding is a serious complication often requiring re-operation. METHODS This retrospective cohort study compared 30-day outcomes following primary LSG in patients receiving intra-operative TXA (March 2020-July 2022) to those who did not (March 2011-March 2020). The primary outcome was postoperative bleeding (Hb < 9 g/dL) requiring transfusion or re-operation. Secondary outcomes were incidence of VTE, serious postoperative complications (Clavien-Dindo > grade 3) and death. Patients underwent standardised-protocol LSG without staple line re-enforcement under a single surgeon within the independent sector (private practice). TXA 1 g intravenous was administered immediately after a methylene blue leak test, prior to extubation. RESULTS TXA group had 226 patients and non-TXA group had 192 patients. Mean age was 40.5 ± 10.3 and 39.1 ± 9.8 years, respectively. In the TXA group, no postoperative bleeds [versus 3 (1.6%) in non-TXA group, p = 0.0279] occurred. One staple line leak (0.4%) occurred in the TXA group compared to zero in the non-TXA group (p = ns). There was no VTE or death. CONCLUSIONS This is the largest cohort study of intra-operative TXA in primary LSG to date, which demonstrates significant decrease in postoperative bleeding without increasing VTE risk. The authors recommend administration of TXA immediately following leak test, or removal of bougie to maximise efficacy. Data of TXA in LSG is awaited from the randomised controlled PATAS trial.
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Affiliation(s)
- Naveed Hossain
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Vasha Kaur
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Mostafa Mahran
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Abdul Quddus
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Santanu Mukhopadhyay
- Department of Anaesthesia, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Akshat Shah
- Department of Anaesthesia, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Sanjay Agrawal
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK.
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Meza Monge K, Domene SS, Diaz Mendoza DL, Vidal-Gallardo A, Alfaro Llique AM, Rodriguez M, Premchandra P, Anwar Pandya S, Arruarana VS, Aleman Paredes K, Calderon Martinez E. Effectiveness of Tranexamic Acid in Trauma Patients: A Systematic Review. Cureus 2024; 16:e52111. [PMID: 38213943 PMCID: PMC10783610 DOI: 10.7759/cureus.52111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 01/13/2024] Open
Abstract
Tranexamic acid (TXA), a fibrinolytic agent, effectively inhibits plasminogen activation, thereby reducing fibrinolysis and hemorrhage. This study focused on its application in trauma patients undergoing emergency surgery, a critical area due to trauma's significant role in mortality. Our investigation involved a meticulous screening of randomized controlled trials from databases including Scopus, PubMed, Web of Science, and Cochrane. The findings indicate that TXA intervention is promising in enhancing outcomes for trauma patients. However, the drug's effectiveness may vary based on the specific nature of the medical condition. In summary, robust evidence suggests that TXA can diminish blood loss, lower transfusion rates, reduce complications, and improve hemoglobin and hematocrit levels in surgical patients. Consequently, TXA should be considered a crucial medication, readily available to mitigate morbidity and mortality in surgical settings. Future research should explore factors influencing TXA's effectiveness in traumatic brain injury cases and across a broad spectrum of surgical scenarios in diverse patient populations. This would further guide clinicians in refining and optimizing the use of TXA.
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Affiliation(s)
- Kenneth Meza Monge
- General Practice, Universidad Nacional Autónoma de Mexico, Mexico City, MEX
| | - Sabrina S Domene
- General Practice, Universidad Nacional de Mar del Plata, Mar del Plata, ARG
| | | | | | | | | | - Pooja Premchandra
- General Practice, American International Medical University, Gros Islet, LCA
| | | | - Victor S Arruarana
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
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Nagasawa H, Omori K, Muramatsu KI, Takeuchi I, Ohsaka H, Ishikawa K, Yanagawa Y. Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis. Int J Emerg Med 2023; 16:70. [PMID: 37828443 PMCID: PMC10568871 DOI: 10.1186/s12245-023-00550-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Traumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS. METHODS The Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians' interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed. RESULTS Of the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11-5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16-6.64) may have increased the return of spontaneous circulation (ROSC) rate. CONCLUSIONS The results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA.
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Affiliation(s)
- Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Ken-ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
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