Introduction of a standardised protocol, including systematic use of tranexamic acid, for management of severe adult trauma patients in a low-resource setting: the MSF experience from Port-au-Prince, Haiti

Autor: Nathalie Edema, Rose Berly Massenat, Guido Benedetti, Rafael Van den Bergh, Alessandro Jachetti, Sophia C. Woolley, Miguel Trelles
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Tranexamic acid
Adolescent
lcsh:Special situations and conditions
Context (language use)
Hemorrhage
Trauma
law.invention
03 medical and health sciences
Young Adult
0302 clinical medicine
Randomized controlled trial
Clinical Protocols
law
medicine
Humans
030212 general & internal medicine
Developing Countries
Low-resource setting
Cause of death
Aged
Retrospective Studies
business.industry
Mortality rate
lcsh:RC952-1245
lcsh:Medical emergencies. Critical care. Intensive care. First aid
030208 emergency & critical care medicine
Emergency room
Odds ratio
lcsh:RC86-88.9
Middle Aged
medicine.disease
Intensive care unit
Antifibrinolytic Agents
Haiti
Emergency medicine
Emergency Medicine
Medécins sans Frontières
Wounds and Injuries
Female
Triage
business
Penetrating trauma
medicine.drug
Research Article
Zdroj: BMC Emergency Medicine
BMC Emergency Medicine, Vol 19, Iss 1, Pp 1-9 (2019)
ISSN: 1471-227X
Popis: Background Bleeding is an important cause of death in trauma victims. In 2010, the CRASH-2 study, a multicentre randomized control trial on the effect of tranexamic acid (TXA) administration to trauma patients with suspected significant bleeding, reported a decreased mortality in randomized patients compared to placebo. Currently, no evidence on the use of TXA in humanitarian, low-resource settings is available. We aimed to measure the hospital outcomes of adult patients with severe traumatic bleeding in the Médecins Sans Frontières Tabarre Trauma Centre in Port-au-Prince, Haiti, before and after the implementation of a Massive Haemorrhage protocol including systematic early administration of TXA. Methods Patients admitted over comparable periods of four months (December2015- March2016 and December2016 - March2017) before and after the implementation of the Massive Haemorrhage protocol were investigated. Included patients had blunt or penetrating trauma, a South Africa Triage Score ≥ 7, were aged 18–65 years and were admitted within 3 h from the traumatic event. Measured outcomes were hospital mortality and early mortality rates, in-hospital time to discharge and time to discharge from intensive care unit. Results One-hundred and sixteen patients met inclusion criteria. Patients treated after the introduction of the Massive Haemorrhage protocol had about 70% less chance of death during hospitalization compared to the group “before” (adjusted odds ratio 0.3, 95%confidence interval 0.1–0.8). They also had a significantly shorter hospital length of stay (p = 0.02). Conclusions Implementing a Massive Haemorrhage protocol including early administration of TXA was associated with the reduced mortality and hospital stay of severe adult blunt and penetrating trauma patients in a context with poor resources and limited availability of blood products.
Databáze: OpenAIRE
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