Journal of Acute Care Surgery

Trauma, Basic

Tranexamic Acid in Trauma Management: A Review of Evidence: Namryeol Kim; J Acute Care Surg 2023;13(3):85-94. Published online November 23, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.3.85

Abstract
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Hemorrhage is the leading cause of death in trauma patients and trauma induced coagulopathy (TIC) is a major contributor to bleeding mortality. TIC has a diverse pathophysiology triggered by injury and hypoperfusion, including platelet dysfunction, endotheliopathy, fibrinogen or thrombin abnormalities, and dysregulated fibrinolysis. Early fluid resuscitation, appropriate blood transfusion, and definitive control of bleeding are essential components of initial management for TIC. Additionally, tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a potential adjunctive therapy following the 2010 landmark trial that demonstrated the benefit of early administration of TXA in reducing trauma patient mortality (CRASH-2). This review provides an analysis of the current literature on the use of TXA in trauma patients. It critically evaluates the evidence on the effect of TXA on TIC and other clinical outcomes, emphasizing the time-sensitive nature of TXA administration and the variation of its effect depending on the severity and location of injury. It also discusses the optimal dosage, timing, and safety of TXA, as well as the challenges and limitations of existing studies. Furthermore, it highlights the importance of individualized treatment approaches based on the fibrinolysis status of TIC and the value of goal-directed therapy guided by viscoelastic hemostatic assays for the appropriate use of TXA.

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Pharmacokinetics of Tranexamic Acid (TXA) Delivered by Expeditious Routes in a Swine Model of Polytrauma and Hemorrhagic Shock
Mallori Wilson, Sean Stuart, Brittany Lassiter, Timothy Parker, Clyde Martin, Robert Healy, Christopher Treager, Eric Sulava, Lorie Gower, Pravina Fernandez, Emily Friedrich
Prehospital Emergency Care.2024; 28(5): 680. CrossRef

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Critical care

Usefulness of Echocardiography for General Surgery Patients on Intensive Care Units: When and How?: Jai-Hyun Chung, Namryeol Kim; J Acute Care Surg 2021;11(1):22-29. Published online March 24, 2021; DOI: https://doi.org/10.17479/jacs.2021.1.22

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Purpose
Echocardiography is useful in the management of critically ill patients, but there are few studies on the usefulness of an echocardiography for critical general surgery patients. This study aimed to address this by analyzing the indications and findings for and clinical outcomes between (1) chest trauma; (2) cardiac specific pathology; and (3) hemodynamic instability groups of critical general surgery patients

Methods
Retrospective analysis was performed on the medical records data from the last 5 years of general surgery patients who were admitted to the intensive care unit (ICU) and had an echocardiography at least once during their ICU stay. The patient data were divided into 3 groups according to the indication for an echocardiography and based on the clinical situation. Demographics, the ratio of positive echocardiography findings, and clinical outcomes including the length of hospital stay, length of ICU stay, and in-hospital mortality were analyzed among these groups.

Results
There were statistical differences in the rate of positive echocardiography findings (p = 0.018) and in-hospital mortality (p = 0.001) amongst the groups with different echocardiography indications; there was no difference in the length of stay. Patients who had an echocardiography due to hemodynamic instability or cardiologic pathology presented with a higher ratio of positive echocardiography findings and mortality, compared with the chest trauma patient group. The chest trauma group showed the lowest rate of positive echocardiography findings (7%).

Conclusion
Echocardiographies are useful for general surgery patients in ICUs when there are indications such as previous cardiac pathology history or hemodynamic instability.

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System

Organization and Roles of the Trauma Team: Namryeol Kim; J Acute Care Surg 2016;6(2):46-53. Published online October 30, 2016; DOI: https://doi.org/10.17479/jacs.2016.6.2.46

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In a narrow sense, the trauma team is intra-hospital organization that perform the initial assessment and resuscitation for the victims. Cooperation with the administrative and governance body of the hospital is essential for the function as a trauma center. The hospital could be as a core of the trauma care system with this support. Essential to this core position is a hospital trauma program that regulates and supports the trauma team activities. This trauma program consists of the hospital governance, administration, the trauma team and leader, trauma program manager, the registrar and the multidisciplinary committee of the performance improvement program. The essential elements of the trauma team include a trauma surgeon, an emergency physician, emergency department nurses, a laboratory and radiology technician, an anesthesiologist and a scribe. The team leader should be a trauma surgeon and coordinate the multidisciplinary professions in the team during the entire trauma care process. Clear criteria for the trauma team activation should be defined in advance. The composition of the team and the activation criteria may vary with the hospital capacity, the severity of injury, and the level of activation. The tiered criteria are based on clinical information from the field: physiologic and anatomic conditions and mechanism of injury and are recommended. The multidisciplinary committee for the performance improvement should monitor and assess trauma program outcomes. These activities will lead to trauma care improvements.