SAQ 296 – Trauma – tranexamic acid and massive transfusion targets

Trauma – tranexamic acid and massive transfusion targets.

a. PATCH-Trauma primary finding

• No significant difference in survival with favourable functional outcome at six months.

b. TEG-guided replacement benefits

• Lower blood-product use, reducing cost, wastage, and transfusion-related complications.
• Improved outcomes such as bleeding rate, length of stay, mortality, or survival.

c. Resuscitation targets

• Permissive hypotension, such as MAP >65 mmHg, SBP >90 mmHg, or palpable peripheral pulse.
• Temperature >35 C.
• pH >7.2 and base excess <6.
• Ionised calcium >1.1 mmol/L.
• Platelets >50 x 10^9/L.
• PT/APTT <1.5 times normal.
• Fibrinogen >2.0 g/L; >1.0 g/L accepted in some references.
• Lactate <4 mmol/L.
• Normal TEG/ROTEM trace.

d. Massive transfusion complications

• Volume overload.
• Dilutional coagulopathy.
• Transfusion-related acute lung injury.
• Hyperkalaemia.
• Hypocalcaemia from citrate toxicity.
• ABO incompatibility or haemolytic reaction.
• Blood-borne infection.
• Hypothermia.
• Metabolic acidosis.
• Hypernatraemia, especially with renal, liver, or cardiac disease.