More severely injured survive
Zurich University Hospital, Zurich Protection & Rescue and Rega have introduced new measures for the care of seriously injured patients. Less blood loss and targeted medication at the scene of the accident massively increase the patient's chances of survival.
Anyone who suffers a serious injury today has a significantly better chance of survival than a few years ago. Improvements in surgical first aid and individualized measures that reduce blood loss contribute to this. As a result, the need for so-called massive transfusions (more than 10 bags of blood by the time a patient enters the intensive care unit) among severely injured patients dropped from 12 to 4 percent. During the measured period, only 27 percent of patients needed red blood cell transfusions instead of 53 percent, and only 6 percent needed blood plasma instead of 31 percent. Although life-saving for a small proportion of seriously injured patients, foreign blood is always a burden for the body and can trigger complications such as allergic reactions, cardiovascular complaints, fever or inflammation.
Overall, the new measures at the University Hospital Zurich (USZ) mean that 62 percent more patients survive their serious injuries than a few years ago. In addition, the injured need to be treated in intensive care for less time, and the overall length of hospital stay was reduced by three days.1)
Therapy begins at the scene of the accident
In 2010, an international study showed that administration of clot-stabilizing tranexamic acid improved survival in trauma patients.2) In order to take advantage of the positive effect of early tranexamic acid administration, Schutz & Rettung and Rega, in collaboration with the University Hospital Zurich, introduced the administration of tranexamic acid at the scene of the accident in 2013 instead of in the hospital.
Since then, the effect of this measure has been investigated in a joint study led by Dr. Philipp Stein, senior physician at the Institute of Anesthesiology of the USZ. In the publication recently published in "Anesthesia & Analgesia", it was demonstrated that the administration of tranexamic acid already massively counteracts a coagulation disorder at the scene of the accident.3) This study also demonstrated for the first time worldwide that the current dosage of the drug may be insufficient in some patients and needs to be specifically adjusted.4) For the study, data from seriously injured patients admitted by Schutz & Rettung Zurich and Rega to the cantonal hospitals of St. Gallen and Lucerne and to the University Hospital of Zurich were analyzed from December 2014 to March 2016.
Rapid transfer from research to practice
Thanks to the collaboration between the University Hospital Zurich, Schutz & Rettung Zurich and Rega, it has been possible in recent years to rapidly translate findings from research into practice. Patients in the Zurich region and throughout Switzerland benefit from this proven cooperation, which is to be continued with further projects.
Press release University Hospital Zurich
Sources:
1) Stein P, Kaserer A, Sprengel K, Wanner G A, Seifert B, Theusinger O M, Spahn DR (2017). Change of transfusion and treatment paradigm in major trauma patients. Anaesthesia, 72(11), 1317-1326.
2) CRASH-2 Trial collaborators (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, 376(9734), 23-32.
3) Stein P, Studt JD, Albrecht R, Müller S, von Ow D, Fischer S, Seifert B, Mariotti S, Spahn DR, Theusinger OM (2018). The Impact of Prehospital Tranexamic Acid on Blood Coagulation in Trauma Patients. Anesthesia and Analgesia, 126(2), 522-529.
4) Grassin-Delyle S, Theusinger OM, Albrecht R, Mueller S, Spahn DR, Urien S, Stein P (2018). Optimisation of the dosage of tranexamic acid in trauma patients with population pharmacokinetic analysis.. Anaesthesia.
