In trauma patients, bleeding can lead to coagulopathy, hemorrhagic shock, and multiorgan failure, and therefore is of fundamental significance in regard to early morbidity. We conducted a meta-analysis to evaluate the efficacy and safety of tranexamic acid (TXA) in civil and military settings and its impact on in-hospital mortality (survival to hospital discharge or 30-day survival), intensive care unit and hospital length of stay, incidence of adverse events (myocardial infarct and neurological complications), and volume of blood product transfusion. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic review of the literature using PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Central Register and Controlled Trials (CENTRAL) database was conducted from inception to 10 January 2021. In-hospital mortality was reported in 14 studies and was 15.5% for the TXA group as compared with 16.4% for the non-TXA group (OR = 0.81, 95% CI 0.62–1.06, I2 = 83%, p = 0.12). In a civilian TXA application, in-hospital mortality in the TXA and non-TXA groups amounted to 15.0% and 17.1%, respectively (OR = 0.69, 95% CI 0.51–0.93, p = 0.02, I2 = 78%). A subgroup analysis of the randomized control trial (RCT) studies showed a statistically significant reduction in in-hospital mortality in the TXA group (14.3%) as compared with the non-TXA group (15.7%, OR = 0.89, 95% CI 0.83–0.96, p = 0.003, I2 = 0%). To summarize, TXA used in civilian application reduces in-hospital mortality. Application of TXA is beneficial for severely injured patients who undergoing shock and require massive blood transfusions. Patients who undergo treatment with TXA should be monitored for clinical signs of thromboembolism, since TXA is a standalone risk factor of a thromboembolic event and the D-dimers in traumatic patients are almost always elevated.
INTRODUCTION:Despite the introduction of supraglottic devices for ventilation, endotracheal intubation is still a gold standard for airway management in both prehospital and operating theatre conditions. This systematic review and meta-analysis were conducted to investigate the effectiveness and safety of Airtraq vs. Macintosh laryngoscope for endotracheal intubation during general anesthesia. MATERIAL AND METHODS:The current issue of Pubmed, Embase, Cochrane, Web of science, Scopus (from database inception to October 20, 2020) was searched. Randomized controlled trials (RCT) comparing Airtraq and Macintosh laryngoscope were included in this meta-analysis. The primary outcomes were the success rate of first attempt intubation and intubation time. Secondary outcomes were overall intubation success rate, malposition, and adverse events. Review Manager 5.4 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. RESULTS:Seventeen studies were included in the review for data extraction. First attempt success rate was 85.6% for ATQ vs. 68.4% for MAC (OR = 3.00; 95% CI: 1.37, 6.60; p = 0.006; I 2 = 63%). The use of ATQ and MAC for intubation in cervical spine immobilization was associated with the effectiveness of the first intubation attempt at 98.6% vs. 71.1% (OR = 16.40; 95% CI: 3.55, 78.87; p < 0.001; I 2 = 0%). Intubation time with ATQ was shorter than with MAC (MD = -3.19; 95% CI: -9.33, 2.95; p = 0.31; I 2 = 97%). The endotracheal intubation during cervical spinal intubation was associated with significantly shorter procedure duration for ATQ than for MAC (MD = -10.30; 95% CI: -18.43, -2.18; p = 0.01; I 2 = 74%). The total efficacy of intubation, which for ATQ and MAC varied and was 86.7% vs. 80.6% respectively (OR = 2.88; 95% CI: 1.61, 5.13; p < 0.001; I 2 = 0%). CONCLUSIONS:Based on the results of this analysis, we conclude that ATQ can reduce the failed first intubation attempt, especially in cervical manual inline stabilization patients, and reduces the time needed to obtain airway management, but does not provide significant benefits on other adverse events associated
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