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

Alessandro Jachetti, Rose Berly Massénat, Nathalie Edema, Sophia C. Woolley, Guido Benedetti, Rafael Van Den Bergh, Miguel Trelles

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Article number56
JournalBMC Emergency Medicine
Volume19
Issue number1
DOIs
Publication statusPublished - Oct 18 2019
Externally publishedYes

Fingerprint

Haiti
Tranexamic Acid
Hemorrhage
Wounds and Injuries
Length of Stay
Mortality
Triage
Trauma Centers
South Africa
Hospital Mortality
Multicenter Studies
Intensive Care Units
Cause of Death
Hospitalization
Odds Ratio
Placebos
Outcome Assessment (Health Care)
Confidence Intervals

Keywords

  • Emergency room
  • Haiti
  • Low-resource setting
  • Medécins sans Frontières
  • Tranexamic acid
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

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. / Jachetti, Alessandro; Massénat, Rose Berly; Edema, Nathalie; Woolley, Sophia C.; Benedetti, Guido; Van Den Bergh, Rafael; Trelles, Miguel.

In: BMC Emergency Medicine, Vol. 19, No. 1, 56, 18.10.2019.

Research output: Contribution to journalArticle

Jachetti, Alessandro ; Massénat, Rose Berly ; Edema, Nathalie ; Woolley, Sophia C. ; Benedetti, Guido ; Van Den Bergh, Rafael ; Trelles, Miguel. / 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. In: BMC Emergency Medicine. 2019 ; Vol. 19, No. 1.
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abstract = "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 M{\'e}decins Sans Fronti{\`e}res 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.",
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AU - Massénat, Rose Berly

AU - Edema, Nathalie

AU - Woolley, Sophia C.

AU - Benedetti, Guido

AU - Van Den Bergh, Rafael

AU - Trelles, Miguel

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AB - 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.

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