Tranexamic acid (TXA) is currently being administered to injured patients by many prehospital air and ground systems, despite a lack of evidence supporting or refuting its efficacy in preventing hemorrhage. Several studies examining prehospital use of TXA are currently in progress, but until now there have been no guidelines for healthcare professionals administering TXA to patients. A new guidance document published in Prehospital Emergency Care provides best practices for TXA administration by Emergency Medical Services (EMS) based on the best evidence currently available.
Physicians from a number of hospitals and medical organizations collaborated on this guidance document, which has been endorsed by the American College of Surgeons-Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians.
"The prehospital use of TXA has become widespread in many areas," says the lead author Dr. Peter E. Fischer, of the F.H. "Sammy" Ross Jr. Trauma Center at Carolinas Medical Center. "Data supporting the use in this environment is limited and thus the organizations involved cannot endorse or oppose its use, but wanted to provide some best practices to EMS organizations which are already using TXA."
All recommendations are predicated upon the understanding that hemorrhage control and resuscitation must remain the priority for EMS responders treating a bleeding patient. TXA administration should never supersede field bleeding control techniques, rapid transport to a trauma center, or the administration of blood or plasma.
According to the guidance document, EMS agencies and receiving trauma centers should develop protocols to ensure that, following prehospital TXA administration, patients receive the appropriate bolus dose in the field and infusion dose at the hospital, and that repeat doses are avoided.
"We anxiously await the results of multiple ongoing prehospital trials, but until that time we hope this document provides some guidance to improve patient care to trauma systems which choose to use TXA in the prehospital environment," concludes Dr. Fischer.