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Tranexamic Acid for Traumatic Brain Injury - Resuscitation Outcomes Consortium

 

TXA MikeVerkest

 

 

 

Hello everyone!
 
 
I'd be remiss if I didn't take few minutes to introduce myself! My name is Mike Verkest and I am
currently an education consultant for FlightBridgeEd team and the EMS training officer for AMR
Multnomah County (Portland) , Oregon. My EMS career started as a volunteer in rural Southern Oregon
where I practiced as an EMT, EMT-I and Paramedic. I moved to Portland in 2004 as an operations
supervisor. In 2008, I took over the clinical side of the house. Multnomah County is a fantasist place to
practice prehospital medicine. We have some of the most progressive protocols in the country, we have
great relationships with our fire partners and we take excellent care of our patients. We have a very
involved medical director who always hand his fingers on the pulse of the next big thing. Oregon Health
Sciences University (OHSU) sits on Marquam Hill overlooking the city of Portland. OHSU is one of the
two Level 1 trauma facilities in the state and as a top research institution, is also always on the leading
edge of discovery. OHSU researchers as part of the resuscitation outcomes consortium (ROC) and
paramedics from AMR in Multnomah and Clackamas counties will soon begin a new research project.
TXA in Traumatic Brain Injury. 
 
Most providers know that TXA is not new and in fact, is widely used in EMS and in ED's across the
country. The benefits of TXA have been proven in patients who are bleeding and require massive
transfusion. The studies (CRASH-2 and MATTERS) have clearly shown that TXA administration within 3
hours is the key...in fact, the sooner the better.  There are, within those studies a group of patients that
had TBI. A small study out of Thailand (n=243) showed that patients with TBI (as diagnosed by CT) that
were given TXA had a 7-10% reduction in mortality, hemorrhage progression was reduced and overall
survival was better.  
 
This study is exciting for a number of reasons. 1. Once the primary injury has occurred, there isn't
typically much EMS can do. We can make sure the patient gets to the right facility, does not get hypoxic
and control seizures. Clearly, the hospital has its work cut out for them as these patients usually require
an all hands on deck approach to the resuscitation. 2. As the previous studies showed within 3 hours
showed a benefit, it also showed that within an hour was even better. Our aim will be to administer the
study medication within minutes of the injury.
Lets talk about our study:
The ROC TXA in TBI randomized placebo controlled trail that has 3 treatment
arms. 
 
1gm of TXA prehospital, followed by 1gm over 8 hrs
2gm of TXA prehospital, followed by 2gm over 8 hrs
Placebo prehospital , followed by Placebo over 8 hrs
 
Inclusion criteria:
 
Blunt of penetrating TBI
All SBP 90 or better prior to enrollment
GCS 12 or less (prior to RSI or sedation) 
Successful IV (cannot give via I/O)
15 years old or > 50kg
Transport destination is OHSU (we have another L1trauma center in our area, but the are unable to
participate)
 
Exclusion criteria:
 
Prisoner, pediatric or pregnancy 
Patient having acute MI or CVA
Active seizure or hx of seizure (if known)
GCS 3 with no reactive pupils
> 20 BSA Burns
EMS CPR
 
The study is looking to enroll 1,002 patients from the U.S and Canadian ROC sites. you can find our
more information about the ROC TXA in TBI study by visiting 
 

More information is available at website: www.ClinicalTrials.gov  

Enter study ID: NCT01990768


 
ROC specific information can be found here https://roc.uwctc.org/tiki/tiki-index.php?page=roc-public
 
Thanks for taking some time to read about this exciting research opportunity! I look forward to more
blog posts soon! You can email any questions to This email address is being protected from spambots. You need JavaScript enabled to view it.
 
 

Thanks! 
 
Mike 

 

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