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Vorhaltung von Tranexamsäure im deutschen Rettungsdienst

Eine nationale Umfrage

Tranexamic acid in the German emergency medical service

A national survey

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Zusammenfassung

Hintergrund

Die europäischen Leitlinien zum Management der schweren Blutung und Koagulopathie nach Trauma empfehlen seit dem Jahr 2013 die frühestmögliche Gabe von Tranexamsäure (TXA) zur Inhibierung der Hyperfibrinolyse, die im Zuge der traumaassoziierten Koagulopathie (TIK) bereits bei Klinikaufnahme bestehen kann. Weiter empfehlen die Leitlinienautoren, dass Behandlungsalgorithmen zum Management der schweren Blutung nach Trauma die präklinische Applikation von TXA beinhalten sollten. Daten zur präklinischen Vorhaltung von TXA in Deutschland existieren bislang nicht.

Fragestellung

Ziel der Arbeit war es, aussagekräftige Daten über die Vorhaltung von TXA im deutschen Rettungsdienst und zur Behandlung der TIK zu generieren.

Material und Methoden

Es wurde ein dreiteiliger Fragebogen entwickelt. Im Zeitraum vom 01.07.2015 bis 31.08.2015 wurden insgesamt 326 Ärztliche Leiter Rettungsdienst (ÄLRD) in Deutschland per E‑Mail zu einer anonymisierten Onlineumfrage eingeladen.

Ergebnisse

Der Onlinefragebogen wurde von 163 ÄLRD beantwortet. Hieraus ergab sich eine Rücklaufquote von 50 %. TXA wurde zum Erhebungszeitpunkt in 52,8 % der Rettungsdienstbereiche vorgehalten. In 26 % der Bereiche, die keine TXA vorhielten, ist dies für die Zukunft geplant. Die Vorhaltungsquote stieg seit 2010 deutlich an. Maßgeblich hierfür wurden Leitlinienempfehlungen genannt. SOPs (Standard Operating Procedures) zur präklinischen Anwendung von TXA existierten in 17,4 %. Eine Dosisempfehlung wurde von 76,7 % (n = 66) der ÄLRD gegeben. Über 80 % der Dosierungsempfehlungen orientierten sich an den internationalen Empfehlungen.

Schlussfolgerung

TXA wurde zum Erhebungszeitpunkt mit steigender Tendenz in über der Hälfte der Rettungsdienstbereiche vorgehalten. Eine flächendeckende Vorhaltung ergibt sich hieraus jedoch noch nicht.

Abstract

Background

Trauma-induced coagulopathy, one of the leading causes of trauma-related death, is detected in about one of four trauma patients upon hospital admission. The current European Management of Major Bleeding and Coagulopathy Following Trauma guidelines, published in 2013, recommend that tranexamic acid (TXA) be administered as early as possible to inhibit hyperfibrinolysis (grade of recommendation (GoR 1A)). Furthermore, it is suggested that protocols for the management of patients with bleeding or showing signs of bleeding include the administration of the first dose of TXA at the site of injury or during transportation to hospital (GoR 2C).

There is no current data showing to what extent TXA is used in the pre-hospital settings in Germany.

Objectives

This study aimed to collect data about the availability of TXA in the German emergency medical service (EMS). We tried to determine how many EMS stored and used TXA, under which circumstances the substance was used and whether any standard operating procedures (SOPs) were in use. The study also tried to determine what dosage recommendations exist.

Materials and methods

Between 1 July and 31 August 2015, a total of 326 German emergency medical directors (EMDs) were asked to take part in a survey, which involved answering an online questionnaire.

Results

Altogether 163 EMD answered the questionnaire (response rate 50%). The results showed that 52.8% of EMDs stored TXA in their vehicles and 26% planned to do so in the future. The availability of TXA in the EMS has increased since 2010. Most EMDs stated that guidelines were the reason for this. SOPs existed in 17.4%. Dosage recommendations were defined by the EMDs in 76.7%. More than 80% of dosage recommendations followed the European guideline.

Conclusion

The survey shows a widespread distribution of TXA in the German EMS, which has significantly increased between 2010 and 2015. However, nationwide distribution has not yet been established.

This rise in distribution is interpreted as a reaction to national and European guidelines for the management of severe bleeding and trauma care.

A remaining question is to determine which patients should be treated with TXA, as hyperfibrinolysis is not detectable at the site of injury.

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Literatur

  1. Andersson L, Nilsson IM (1969) Amca (Aminomethyl Cyclohexane Carboxylic acid, Cyklo-Kapron®) a potent Haemostatic agent in urinary tract bleeding. Scand J Urol Nephrol 3:169–176. doi:10.3109/00365596909135400

    Article  CAS  PubMed  Google Scholar 

  2. Ausset S, Glassberg E, Nadler R et al (2015) Tranexamic acid as part of remote damage-control resuscitation in the prehospital setting: A critical appraisal of the medical literature and available alternatives. J Trauma Acute Care Surg 78:70–S75. doi:10.1097/TA.0000000000000640

    Article  Google Scholar 

  3. Bosse G, Breuer J‑P, Spies C (2006) The resistance to changing guidelines – what are the challenges and how to meet them. Best Pract Res Clin Anaesthesiol 20:379–395. doi:10.1016/j.bpa.2006.02.005

    Article  PubMed  Google Scholar 

  4. Brohi K, Singh J, Heron M, Coats T (2003) Acute traumatic Coagulopathy. J Trauma Inj Infect Crit Care 54:1127–1130. doi:10.1097/01.TA.0000069184.82147.06

    Article  Google Scholar 

  5. Brohi K, Cohen MJ, Davenport RA (2007) Acute coagulopathy of trauma: Mechanism, identification and effect. Curr Opin Crit Care 13:680–685. doi:10.1097/MCC.0b013e3282f1e78f

    Article  PubMed  Google Scholar 

  6. Brown JB, Neal MD, Guyette FX et al (2015) Design of the Study of Tranexamic Acid during Air Medical Prehospital transport (STAAMP) trial: Addressing the knowledge gaps. Prehosp Emerg Care 19:79–86. doi:10.3109/10903127.2014.936635

    Article  PubMed  Google Scholar 

  7. Casati V, Romano A, Novelli E, D’Angelo A (2010) Tranexamic acid for trauma. Lancet 376:1049–1050. doi:10.1016/S0140-6736(10)61477-8

    Article  PubMed  Google Scholar 

  8. CRASH-2 trial collaborators, Shakur H, Roberts I et al (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. Lancet Lond Engl 376:23–32. doi:10.1016/S0140-6736(10)60835-5

    Article  Google Scholar 

  9. DGU (2011) S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. AWMF-Register-Nr. 012/019

  10. Deutsche Gesellschaft für Unfallchirurgie (2016) S3 – Leitlinie Polytrauma/Schwerverletzten-Behandlung. http://www.awmf.org/leitlinien/detail/ll/012-019.html. Zugegriffen: 18. Oktober 2016

    Google Scholar 

  11. Guth MC, Kaufner L, Kleber C, von Heymann C (2012) Behandlung der traumainduzierten Koagulopathie – Was ist die Evidenz? Anasthesiol Intensivmed Notfallmed Schmerzther 47:528–540

    Article  PubMed  Google Scholar 

  12. Hamada SR, Gauss T, Pann J et al (2015) European trauma guideline compliance assessment: The ETRAUSS study. Crit Care. doi:10.1186/s13054-015-1092-5

    Google Scholar 

  13. Hess JR, Brohi K, Dutton RP et al (2008) The Coagulopathy of Trauma: A Review of Mechanisms. J Trauma Inj Infect Crit Care 65:748–754. doi:10.1097/TA.0b013e3181877a9c

    Article  CAS  Google Scholar 

  14. Ker K, Kiriya J, Perel P et al (2012) Avoidable mortality from giving tranexamic acid to bleeding trauma patients: An estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial. BMC Emerg Med 12:3. doi:10.1186/1471-227X-12-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kunze-Szikszay N, Krack LA, Wildenauer P et al (2016) The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine. Scand J Trauma Resusc Emerg Med. doi:10.1186/s13049-016-0314-4

    PubMed  PubMed Central  Google Scholar 

  16. Levy JH (2010) Antifibrinolytic therapy: new data and new concepts. Lancet 376:3–4

    Article  PubMed  Google Scholar 

  17. Lipsky AM, Abramovich A, Nadler R et al (2014) Tranexamic acid in the prehospital setting: Israel Defense Forces’ initial experience. Injury 45:66–70. doi:10.1016/j.injury.2013.08.025

    Article  PubMed  Google Scholar 

  18. MacLeod JBA, Lynn M, McKenney MG et al (2003) Early Coagulopathy predicts mortality in trauma. J Trauma Inj Infect Crit Care 55:39–44. doi:10.1097/01.TA.0000075338.21177.EF

    Article  Google Scholar 

  19. Maegele M, Lefering R, Yucel N et al (2007) Early coagulopathy in multiple injury: An analysis from the German Trauma Registry on 8724 patients. Injury 38:298–304. doi:10.1016/j.injury.2006.10.003

    Article  PubMed  Google Scholar 

  20. Mitra B, Mazur S, Cameron PA et al (2014) Tranexamic acid for trauma: Filling the ‘GAP’ in evidence: Tranexamic acid for trauma. Emerg Med Australas 26:194–197. doi:10.1111/1742-6723.12172

    Article  PubMed  Google Scholar 

  21. Morrison JJ (2012) Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg 147:113. doi:10.1001/archsurg.2011.287

    Article  CAS  PubMed  Google Scholar 

  22. Mrochuk M, ÓDochartaigh D, Chang E (2015) Rural trauma patients cannot wait: Tranexamic acid administration by helicopter emergency medical services. Air Med J 34:37–39. doi:10.1016/j.amj.2014.09.004

    Article  PubMed  Google Scholar 

  23. Nadler R, Gendler S, Benov A et al (2014) Tranexamic acid at the point of injury: The Israeli combined civilian and military experience. J Trauma Acute Care Surg 77:146–S150. doi:10.1097/TA.0000000000000325

    Article  Google Scholar 

  24. Pusateri AE, Weiskopf RB, Bebarta V et al (2013) Tranexamic acid and trauma: Current status and knowledge gaps with recommended research priorities. Shock 39:121–126. doi:10.1097/SHK.0b013e318280409a

    Article  PubMed  Google Scholar 

  25. Rappold JF, Pusateri AE (2013) Tranexamic acid in remote damage control resuscitation: Tranexamic Acid in Control Resuscitation. Transfusion (Paris) 53:96S–99S. doi:10.1111/trf.12042

    Article  Google Scholar 

  26. Rossaint R, Bouillon B, Cerny V et al (2016) The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care. doi:10.1186/s13054-016-1265-x

    PubMed  PubMed Central  Google Scholar 

  27. Schöchl H, Frietsch T, Pavelka M, Jámbor C (2009) Hyperfibrinolysis after major trauma: Differential diagnosis of Lysis patterns and prognostic value of Thrombelastometry. J Trauma Inj Infect Crit Care 67:125–131. doi:10.1097/TA.0b013e31818b2483

    Article  Google Scholar 

  28. Spahn DR, Bouillon B, Cerny V et al (2013) Management of bleeding and coagulopathy following major trauma: An updated European guideline. Crit Care 17:1

    Article  Google Scholar 

  29. Traumaregister Deutsche Gesellschaft für Unfallchirurgie DGU Jahresbericht (2015) Jahresbericht 2015. http://www.traumaregister-dgu.de/fileadmin/user_upload/traumaregister-dgu.de/docs/Downloads/TR-DGU-Jahresbericht_2015.pdf. Zugegriffen: 1. Sept. 2016

    Google Scholar 

  30. Vu EN, Schlamp RS, Wand RT et al (2013) Prehospital use of Tranexamic acid for hemorrhagic shock in primary and secondary air medical evacuation. Air Med J 32:289–292. doi:10.1016/j.amj.2013.05.001

    Article  PubMed  Google Scholar 

  31. Wafaisade A, Lefering R, Bouillon B et al (2016) Prehospital administration of tranexamic acid in trauma patients. Crit Care. doi:10.1186/s13054-016-1322-5

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Deutschland

    V. Zickenrott & C. von Heymann

  2. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    I. Greb, A. Henkelmann, F. Balzer & L. Kaufner

  3. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie – Zentrum für Intensiv- und Notfallmedizin, Kliniken des Main-Taunus-Kreises, Bad Soden, Deutschland

    S. Casu

  4. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland

    K. Zacharowski & C. F. Weber

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  1. V. Zickenrott
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Correspondence to V. Zickenrott.

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Interessenkonflikt

V. Zickenrott, I. Greb, A. Henkelmann, F. Balzer, S. Casu, L. Kaufner, C. von Heymann, K. Zacharowski und C. F. Weber geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Dieser Beitrag beinhaltet Daten und Material der Dissertation von V. Zickenrott.

V. Zickenrott und I. Greb teilen sich die Erstautorenschaft.

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Zickenrott, V., Greb, I., Henkelmann, A. et al. Vorhaltung von Tranexamsäure im deutschen Rettungsdienst. Anaesthesist 66, 249–255 (2017). https://doi.org/10.1007/s00101-017-0277-5

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