Bleeding is an important cause of death in trauma victims. In 2010, the CRASH-2 study, a multicentre randomized control trial on the effect of tranexamic acid (TXA) administration to trauma patients with suspected significant bleeding, reported a decreased mortality in randomized patients compared to placebo. Currently, no evidence on the use of TXA in humanitarian, low-resource settings is available. We aimed to measure the hospital outcomes of adult patients with severe traumatic bleeding in the Médecins Sans Frontières Tabarre Trauma Centre in Port-au-Prince, Haiti, before and after the implementation of a Massive Haemorrhage protocol including systematic early administration of TXA. Patients admitted over comparable periods of four months (December2015- March2016 and December2016 - March2017) before and after the implementation of the Massive Haemorrhage protocol were investigated. Included patients had blunt or penetrating trauma, a South Africa Triage Score ≥ 7, were aged 18–65 years and were admitted within 3 h from the traumatic event. Measured outcomes were hospital mortality and early mortality rates, in-hospital time to discharge and time to discharge from intensive care unit. One-hundred and sixteen patients met inclusion criteria. Patients treated after the introduction of the Massive Haemorrhage protocol had about 70% less chance of death during hospitalization compared to the group “before” (adjusted odds ratio 0.3, 95%confidence interval 0.1–0.8). They also had a significantly shorter hospital length of stay (p = 0.02). Implementing a Massive Haemorrhage protocol including early administration of TXA was associated with the reduced mortality and hospital stay of severe adult blunt and penetrating trauma patients in a context with poor resources and limited availability of blood products.

中文翻译：

---

引入标准化方案，包括系统地使用氨甲环酸，以在资源匮乏的情况下管理严重的成人创伤患者：海地太子港的MSF经验

出血是创伤受害者死亡的重要原因。2010年，CRASH-2研究是一项多中心随机对照试验，研究了氨甲环酸（TXA）对涉嫌严重出血的外伤患者的影响，该研究报告了与安慰剂相比，随机分组患者的死亡率降低。目前，尚无证据表明在人道主义，资源贫乏地区使用TXA的证据。我们旨在测量大规模出血方案（包括系统地及早给予TXA）之前和之后，在海地太子港的无国界医生组织塔巴雷创伤中心对患有严重创伤性出血的成年患者的医院结局进行评估。研究了实施大出血方案前后四个月（2015年12月至2016年3月以及2016年12月至2016年3月）的可比期间。包括钝性或穿透性创伤的患者，南非分类评分≥7，年龄18-65岁，在创伤事件发生后3小时内入院。测得的结局为医院死亡率和早期死亡率，住院时间和重症监护病房的出院时间。一百一十六名患者符合入选标准。引入“大出血”方案后接受治疗的患者与“之前”组相比，住院期间的死亡几率降低了约70％（调整后的优势比为0.3，95％的置信区间为0.1-0.8）。他们的住院时间也明显缩短（p = 0.02）。在资源贫乏，血液制品供应有限的情况下，实施包括大面积出血的早期治疗方案在内的大规模出血方案，与降低成人死亡率和减少严重的成人钝器和穿透性创伤患者的住院时间有关。