The Golden Hour

[chbare]

Many of the problems seem to stem from nitric oxide scavenging. Also, blood products are not to be confused with the real thing. Banked blood does not act like "real" blood.

Take care,

chbare.

[tniuqs]

Many of the problems seem to stem from nitric oxide scavenging. Also, blood products are not to be confused with the real thing. Banked blood does not act like "real" blood.

Take care,

chbare.

I am not certain that its nitric as much as citrates used as a preservative's hence a metabolic acidosis (but looking at the books AGAIN) ... plus it gives me one headache doing dialysis and checking ionized calcuim every dang sample.

Citrates screws up clotting factors rest assured, but how else can one stop RBCs in the bag (from becoming a blood pudding) but we can overcome or at least compensate with platelets and the other goodies ... available in Hospital only (at this time)

At least the brits are giving a good run with tranexamic acid, who knows maybe we can stop rushing to hospital and saving our own lives with the positive diesel sign ?

cheers

cheers

Edited August 9, 2010 by tniuqs

[HERBIE1]

Pssst: Hey HERBIE1 over here..

Anti-bleeding drug cheap way to save lives.

Read more: http://www.cbc.ca/he...l#ixzz0w3UO3H1Y

I will look for the real EBM studies.

cheers

Thanks. I'll take a good hard look at this tomorrow. Bed time for this cowboy- have a good one.

[chbare]

I should have specified:

The problems with many of these blood substitutes seem to stem from nitric oxide scavenging.

Take care,

chbare.

[armymedic571]

I think this still begs the question of permissive hypotension in these patients...........

[chbare]

I think this still begs the question of permissive hypotension in these patients...........

Possibly, it's a concept that seems to be in a state of constant transition. In addition, give somebody a head injury and things may change.

Take care,

chbare.

I think this still begs the question of permissive hypotension in these patients...........

Possibly, it's a concept that seems to be in a state of constant transition. In addition, give somebody a head injury and things may change.

Take care,

chbare.

[Kiwiology]

agreed

[tniuqs]

CRASH 2 trial link:

http://www.crash2.lshtm.ac.uk/

Try the PDF file ... just way to too much to post.

http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/20681

By Peggy Peck, Executive Editor, MedPage Today

Published: June 15, 2010

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Earn CME/CE credit for reading medical news

An inexpensive drug approved for treatment of abnormally heavy menstrual flow significantly reduced fatal bleeding in trauma patients, researchers reported.

In a large randomized trial, treatment with tranexamic acid reduced the risk of fatal bleeding events by 15% compared with placebo -- 4.9% versus 5.7% (RR 0.85, 95% CI, 0.76 to 0.96, P=0.0077), according to Ian Roberts, MD, PhD, and Haleema Shakur, MSc, RN, of the London School of Hygiene and Tropical Medicine, and colleagues.

All-cause mortality was also lower in the tranexamic acid group -- 14.5% versus 16% in controls -- and that was also significant (RR 0.91, 95% CI 0.85 to 0.97, P =0.0035), the researchers from the Clinical Randomisation of an Antifibrinolytic in Significant Hemorrhage-2 consortium (CRASH-2) trial reported online in The Lancet.

Action Points

Note that this study describes an off-label use of an FDA approved drug.Explain that the U.S. trauma care system is regionalized, which differs from the trauma care systems in use in most countries included in this study.

Alasdair Conn, MD, chief of emergency medicine at Massachusetts General Hospital, said that although the study was interesting, it was not a practice-changing finding. "I also think that the study should be replicated; there was a study done several years ago in France showing that very tight control of diabetes in ICU patients led to an improvement in survival; the Joint Commission here mandated all hospitals to adopt this but repeat trials did not confirm the finding. In the U.S.A., one could argue that as much of an improvement in survival comes from taking the severely injured patient to the correct hospital as giving them a medication," Conn wrote in an e-mail to MedPage Today/ABC News.

Corey Slovis, MD, chairman of emergency medicine at Vanderbilt University in Nashville, noted that "widespread use of tranexamic acid in the trauma patients would be a major and dramatic change in practice In general."And in the U.S., Slovis explained in an e-mail, such a change might not be justified because the regionalization of trauma care in this country has led to outstanding results. There are "trauma centers and surgeons who essentially do nothing but trauma. Most countries have general surgeons at local hospitals and even some advanced European countries do not always rush people to trauma centers. Think Princess Diana -- in the U.S.A. she would have been a 'scoop and run' and spent 10 minutes or less on scene." The randomized, double-blind, placebo-controlled CRASH-2 trial, which was conducted in 40 countries, randomized 20,211 adult trauma patients who were at high risk for significant bleeding to tranexamic acid or placebo. Randomization took place within eight hours of injury. Tranexamic acid was given at a loading dose of 1 g over 10 minutes and then an infusion of 1 g over eight hours. The primary endpoint was inhospital death within four weeks of injury. Tranexamic acid use was not associated with a significant difference in deaths due to multiorgan failure, head trauma, or other causes, the researchers reported. They noted that the trial provided only limited "insight into how tranexamic acid reduces the risk of death in bleeding trauma patients," because they did not measure fibrinolytic activity and therefore they "cannot conclude that this agent acts by reducing fibrinolysis rather than another mechanism."There was no difference in the rates of transfusion between the two treatment groups, but Roberts and Shakur wrote that measuring blood loss and tracking transfusion rates is difficult among trauma patients. Bleeding at the scene and in the hospital "is often difficult to quantify, such as, for example, bleeding into the chest, abdomen, pelvis, and soft tissues," they wrote. Thus, the lack of difference in transfusion rates could simply be "an indication of the difficulty of accurate estimation of blood loss in trauma patients when assessing the need for transfusion." The observed mortality benefit did not vary substantially according to the time from injury, but "there was some suggestion that early treatment might be more effective," they wrote. Based on the study's results, "tranexamic acid should be considered for use in bleeding trauma patients," they concluded.

In a commentary that accompanied the study, Jerrold H. Levy, MD, of Emory University, wrote that the results showed that "inhibition of fibrinolysis with tranexamic acid after major trauma is an important mechanism to reduce mortality." He also pointed out that "caution is needed before extrapolation of the results of CRASH-2 to other antifibrinolytic agents until they have been studied in a similarly robust manner."

The CRASH-2 study was supported by the United Kingdom National Institute for Health Research Health Technology Assessment Programme, Pfizer, the BUPA Foundation, and J.P. Moulton Charitable Foundation.

Roberts and Shakur declared that they had no conflicts of interest.

Levy said he received research support from Novo Nordisk, and served on the Novo Nordisk steering committee for recombinant factor XIII evaluation in cardiac surgery.

This article was developed in collaboration with ABC News.

[Herbie]

Interesting article. The drug has been around for a long time, but apparently someone figured out another use for it. It certainly sounds like it would have value in certain situations-stopping uncontrolled bleeding is important, but we still need a solution to replace blood that already has been lost.

Clearly we we would need very specific protocols to determine the best use of the product, but I do see potential here.

[armymedic571]

Does anyone here use Hextend (Hespan)? It is a diferent substance, but has been used for years with success????