The Resus Room

Head Injury Updates; Roadside to Resus

22 snips
May 18, 2023
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ADVICE

Use TXA Early For GCS ≤12

  • Consider tranexamic acid for patients with head injury and GCS ≤12 given before imaging and as soon as possible after injury.
  • Use a 2 g IV bolus within 2 hours for adults, or 15–30 mg/kg (max 2 g) for children, replacing bolus+infusion regimens.
INSIGHT

Evidence Is Nuanced, Not Definitive

  • CRASH-3 showed no overall 28-day mortality benefit but suggested benefit in some GCS subgroups, creating residual uncertainty.
  • Rowell et al supported potential mortality reduction with a 2 g bolus, which influenced NICE despite non-definitive primary outcomes.
ADVICE

Switch To 2 g Single Bolus

  • Replace the prior 1 g bolus + 1 g infusion TXA regimen with a single 2 g IV bolus given within 2 hours of injury.
  • Coordinate this change across pre-hospital and in-hospital protocols to avoid system-level mismatch.
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