This is a single-center, not-randomized, open-label, controlled pilot clinical trial. This study compares presence of Trauma Induced Coagulopathy (TIC) and acute traumatic hemorrhage treatment at pre-hospital phase of care with red blood cells (RBC), Tranexamic acid (TXA) and Fibrinogen Concentrate (FC) with the current treatment based on the administration of Crystalloids and TXA.
A pilot, non-randomized, open-label study of two intervention arms and controlled with the standard treatment in which 60 patients affected with acute hemorrhage due to severe trauma will enter the study with the main objective of evaluating the feasibility and the efficacy of early treatment during the pre-hospital care phase with packed red blood cells, fibrinogen concentrate and tranexamic acid (experimental arm) compared to the standard treatment based on crystalloids administration and tranexamic acid (control arm). The secondary objectives are to evaluate the safety and clinical evolution of the patients. Prior to the administration of the treatment, 2 blood samples will be extracted in both groups in order to compare the coagulation status and to be able to perform the pre-transfusion tests. On arrival at the hospital, another sample will be taken to compare changes in coagulation after the administration of the experimental or standard treatment and also between both groups. The assessment of the coagulation status will be made using the values provided by the viscoelastic test (TEG6s). The experimental and standard treatment will be administered endovenously. After treatment, patients will be evaluated up to 30 days.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
79
Administration of 2 mg of FC together with RBC and TXA
Administration of 2 red blood cells concentrates together with FC and TXA
Administration of 1g of TXA together with FC and RBC
Hospital Josep Trueta
Girona, Spain
TEG6s(R) parameters for Trauma Induced Coagulopathy (TIC)
TEG6s(R) parameters that define TIC
Time frame: Basal (at the crash site)
TEG6s(R) parameters for Trauma Induced Coagulopathy (TIC)
TEG6s(R) parameters that define TIC
Time frame: Basal (at the hospital arrival)
All-cause mortality
Mortality for any cause
Time frame: 1 hour post hospital admission
All-cause mortality
Mortality for any cause
Time frame: 6 hours post hospital admission
All-cause mortality
Mortality for any cause
Time frame: 24 hours post hospital admission
Accountability
Red bood cells concentrate accountability
Time frame: 30 days
Temperature storage conditions of the red blood cells concentrate
Red bood cells concentrate out of temperature range for storage
Time frame: 24 hours
All-cause mortality
Mortality for any cause
Time frame: 48 hours post hospital admission
All-cause mortality
Mortality for any cause
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Time frame: 30 days post hospital admission
Adverse Events
Treatment emergent adverse events
Time frame: 30 days post hospital admission (or previously at hospital discharge)
Thromboembolism events
Thromboembolism events
Time frame: 30 days
Crystalloid fluid requirements
Volume of crystalloids required
Time frame: 1 hour (from the crash site to the hospital admission)
Crystalloid fluid requirements
Volume of crystalloids required
Time frame: 30 days post hospital admission (or previously at hospital discharge)
Transfusion requirements
Transfusion requirements of RBC, platelets and plasma
Time frame: 24 hours (or previously at discharge of the emergency room)
Transfusion requirements
Transfusion requirements of RBC, platelets and plasma
Time frame: 30 days post hospital admission (or previously at hospital discharge)
Water balance
Water balance at the Intensive Care Unit (ICU)
Time frame: 24 hours of admission at the ICU
Water balance
Water balance at the Intensive Care Unit (ICU)
Time frame: 72 hours of admission at the ICU
Ventilator-free days
Ventilator-free days at the ICU
Time frame: 30 days