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Rabiee Rad M, Ghasempour Dabaghi G, Amani-Beni R. Efficacy of Epsilon Aminocaproic Acid Versus Placebo in Coronary Artery Bypass Graft: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2024; 26:161-174. [DOI: 10.1007/s11936-024-01039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 07/23/2024]
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Gendler S, Gelikas S, Talmy T, Lipsky AM, Avital G, Nadler R, Radomislensky I, Ahimor A, Glassberg E, Mozer Glassberg Y, Almog O, Yazer MH, Benov A. Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry. Pediatr Crit Care Med 2023; 24:e236-e243. [PMID: 36752620 DOI: 10.1097/pcc.0000000000003202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Tranexamic acid (TXA) administration confers a survival benefit in bleeding trauma patients; however, data regarding its use in pediatric patients are limited. This study evaluates the prehospital treatment with TXA in pediatric trauma patients treated by the Israel Defense Forces Medical Corps (IDF-MC). DESIGN Retrospective, cohort study using the Israel Defense Forces registry, 2011-2021. PATIENTS Pediatric trauma patients less than 18 years old. We excluded patients pronounced dead at the scene. INTERVENTIONS None. SETTING All cases of pediatric trauma in the registry were assessed for treatment with TXA. Propensity score matching was used to assess the association between prehospital TXA administration and mortality. MEASUREMENTS AND MAIN RESULTS Overall, 911 pediatric trauma patients were treated with TXA by the IDF-MC teams; the median (interquartile) age was 10 years (5-15 yr), and 72.8% were male. Seventy patients (7.6%) received TXA, with 52 of 70 (74%) receiving a 1,000 mg dose (range 200-1,000 mg). There were no prehospital adverse events associated with the use of TXA (upper limit of 95% CI for 0/70 is 4.3%). Compared with pediatric patients who did not receive TXA, patients receiving TXA were more likely to suffer from shock (40% vs 10.7%; p < 0.001), sustain more penetrating injuries (72.9% vs 31.7%; p < 0.001), be treated with plasma or crystalloids (62.9% vs 11.4%; p < 0.001), and undergo more lifesaving interventions (24.3% vs 6.2%; p < 0.001). The propensity score matching failed to identify an association between TXA and lesser odds of mortality, although a lack of effect (or even adverse effect) could not be excluded (non-TXA: 7.1% vs TXA: 4.3%, odds ratio = 0.584; 95% CI 0.084-3.143; p = 0.718). CONCLUSIONS Although prehospital TXA administration in the pediatric population is feasible with adverse event rate under 5%, more research is needed to determine the appropriate approach to pediatric hemostatic resuscitation and the role of TXA in this population.
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Affiliation(s)
- Sami Gendler
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Shaul Gelikas
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Tomer Talmy
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Ari M Lipsky
- Department of Emergency Medicine, HaEmek Medical Center, Afula, Israel
| | - Guy Avital
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Roy Nadler
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Irina Radomislensky
- The National Center for Trauma & Emergency Medicine Research, Gertner Institute, Ramat Gan, Israel
| | - Alon Ahimor
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Elon Glassberg
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- The Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Yael Mozer Glassberg
- Institute of Pediatric Gastroenterology, Nutrition and Liver Diseases, Schneider Children Medical Center of Israel, Petah Tikva, Israel
| | - Ofer Almog
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- The Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
- Department of Pathology, Tel Aviv University, Tel Aviv, Israel
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Stein ML, Bilal MB, Faraoni D, Zabala L, Matisoff A, Mossad EB, Mittnacht AJC, Nasr VG. Selected 2022 Highlights in Congenital Cardiac Anesthesia. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00201-X. [PMID: 37085385 DOI: 10.1053/j.jvca.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/23/2023]
Abstract
This article is a review of the highlights of pertinent literature of interest to the congenital cardiac anesthesiologist, and was published in 2022. After a search of the United States National Library of Medicine PubMed database, several topics emerged in which significant contributions were made in 2022. The authors of this manuscript considered the following topics noteworthy to be included in this review-intensive care unit admission after congenital cardiac catheterization interventions, antifibrinolytics in pediatric cardiac surgery, the current status of the pediatric cardiac anesthesia workforce in the United States, and kidney injury and renal protection during congenital heart surgery.
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Affiliation(s)
- Mary L Stein
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Musa B Bilal
- Department of Anesthesiology, Perioperative and Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - David Faraoni
- Department of Anesthesiology, Perioperative and Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Luis Zabala
- Department of Anesthesia and Pain Medicine, UT Southwestern School of Medicine, Children's Medical Center Dallas, Dallas, TX
| | - Andrew Matisoff
- Department of Anesthesiology, Perioperative and Pain Medicine, George Washington University, Children's National Hospital, Washington, DC
| | - Emad B Mossad
- Department of Anesthesiology, Perioperative and Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Alexander J C Mittnacht
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, Valhalla, NY.
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
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