TXA Timing & Hypothermia: The 2 Silent Killers in Trauma Care | Dr. Jeannie Callum

About Dr. Callum:https://research.sunnybrook.ca/researchers/jeannie-callum/https://pathology.queensu.ca/faculty-staff/jeannie-callumhttps://www.researchgate.net/profile/Jeannie-Callumhttps://www.youtube.com/watch?v=paAvUuXDChU&t=962s In this insightful part 2 episode, we explore the critical importance of temperature management and the timely administration of Tranexamic Acid (TXA) for trauma patients in pre-hospital settings. The discussion covers the mechanics and benefits of TXA administration, including its proven effects on reducing mortality in trauma and obstetric hemorrhage cases, as well as its applications in various surgical procedures. We examine the evidence from key trials like Crash-2 and the WOMAN trial, and highlight practical aspects such as storage and dosage. Additionally, the episode addresses the importance of maintaining a patient's body temperature and presents initiatives to improve the efficacy of pre-hospital care, including potential research opportunities and strategies to make workflows more efficient for healthcare professionals.Chapters00:00 Introduction to Pre-Hospital Temperature Management00:46 Understanding TXA Administration Timelines02:08 Case Studies and Anecdotal Evidence03:01 Dosage and Safety of TXA07:02 Storage and Temperature Considerations for TXA09:14 TXA in Various Medical Scenarios22:33 Research and Future Directions for TXA31:48 Conclusion and Key TakeawaysReferences:Ontario Transfusion Quality Improvement Plan.Massive Hemorrhage Protocol Toolkit – Version 1 (October 2021).Available at: https://transfusionontario.org/wp-content/uploads/2021/10/MHP_Toolkit_v1_Oct2021.pdfCallum JL, Karkouti K, Lin Y, et al.The Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial. JAMA Surg. 2020;155(9):e202243.Available at: https://jamanetwork.com/journals/jamasurgery/fullarticle/2771225Gayet-Ageron A, Prieto-Merino D, Ker K, et al.Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: A meta-analysis. Lancet. 2023;401(10378):1344-1353.Available at: https://pubmed.ncbi.nlm.nih.gov/32897344/Yee DA, Knudson MM, Cohen MJ, et al.Prehospital tranexamic acid is associated with improved survival in severely injured patients with major hemorrhage. J Trauma Acute Care Surg. 2023 Nov;95(5):665–671.Available at: https://pubmed.ncbi.nlm.nih.gov/37928456/Roberts I, Shakur H, Coats T, et al.The CRASH-2 trial: A randomized controlled trial and economic evaluation of the effect of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013;17(10):1–79.Available at: https://pubmed.ncbi.nlm.nih.gov/23477634/CRASH-3 trial collaborators.Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): A randomized, placebo-controlled trial. Lancet. 2019;394(10210):1713–1723.Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltextShariff ZA, Joshi N, Reardon PM, et al.Implementation of prehospital tranexamic acid (TXA) in Ontario: A provincial, prospective, collaborative approach. BMC Emerg Med. 2024;24(1):14.Available at: https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-024-01119-2Sperry JL, Guyette FX, Rosario-Rivera BL, et al.Early Cold Stored Platelet Transfusion Following Severe Injury: A Randomized Clinical Trial. Ann Surg. 2024 Aug 1;280(2):212-221.Available at: https://pubmed.ncbi.nlm.nih.gov/38708880/Relke N, Chornenki NLJ, Sholzberg M.Tranexamic acid evidence and controversies: An illustrated review. Res Pract Thromb Haemost. 2021;5(5):e12546.Available at: https://pubmed.ncbi.nlm.nih.gov/34278187/Disclaimer:Always follow your local medical directives, protocols, and the guidance of your medical director or regulatory authority.