Current Practices in Tranexamic Acid Administration for Pediatric Trauma Patients in The United States
Brian Cornelius, DNP CRNA NRP1; Quinn Cummings, MD2; Mathieu Assercq, MD3; Erin Rizzo, MS-IV3; Sonja Gennuso, MD4; Angela Cornelius, MD FACEP5
1Department of Anesthesia, Ochsner LSU Health-Shreveport, Shreveport, LA; 2LSUHSC-Shrveport, Shreveport, LA; 3LSUHSC-Shreveport, Shreveport, LA; 4Department of Anesthesia, LSUHSC-Shreveport, Shreveport, LA; 5Department of Emergency Medicine, LSUHSC-Shreveport, Shreveport, LA
Though controversial, early administration of Tranexamic Acid (TXA) has been shown to reduce mortality in adult patients with major trauma. TXA has also been successfully used in elective pediatric surgery with significant reduction in blood loss and transfusion requirements. However, there are limited data to guide its use in pediatric trauma patients. We sought to determine current practices for TXA administration in pediatric trauma patients in the United States.
After IRB approval, a survey was conducted of all the American College of Surgeons verified Level One and Two Trauma Centers in the United States. The data collected by the survey underwent quantitative analysis.
Of the 363 qualifying centers, we received responses from 220-61% (Overall) and 80 of 99-81% (Verified Pediatric Centers). Of those centers, 148 (67%) reported they care for pediatric trauma patients. These centers saw an average of 513 pediatric trauma patients annually. Of those centers, 52 (35%) report using TXA with the most common initial dosing being 15mg/kg (68%). A follow-up infusion was utilized by 45 (87%) of the programs, most commonly dosed at 2mg/kg/hour utilized by 24 centers (54%).
While the clinical evidence for TXA in pediatric trauma patients is limited, we feel that consideration should be given for use in major trauma with hemodynamic instability or significant risk for ongoing hemorrhage. If available, resuscitation should be guided by Thromboelastogram (TEG) to identify candidates that would most benefit from antithrombolytic administration. This represents a low-cost, low-risk, and high-yield therapy for pediatric trauma patients.
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