Resumo

MEJIA-MANTILLA, Jorge Humberto; PUENTES-MANOSALVA, Fabian Eduardo; CIRO, Juan Diego  e  MORALES, Carlos. Hemorrhage and trauma; advances in the CRASH2 study in Colombia. rev. colomb. cir. [online]. 2009, vol.24, n.3, pp.175-183. ISSN 2011-7582.

Introduction. Trauma is a global epidemic that mainly affects the young and economically productive population in countries with middle and low per capita income. Hemorrhage is responsible for a high proportion of trauma deaths, especially in the first day. Materials and methods. CRASH2 is a clinical, multicentric, double blinded, controlled, randomized trial on the use of a fibrinolytic agent, tranexemic acid, for reduction of transfusions, diminishing the number of operations, and lower mortality in patients that have suffered trauma and significant hemorrhage. In this paper we compare demographic and clinical aspects of the Colombian study population with those of the rest of the world. Because the study is still in progress, the blinded component must continue and therefore no comparison can be made in regard to the treatment groups. It is estimated that the number of patients can be completed by December 2009, and definitive conclusions can be made towards the middle of 2010. Results.The proportion of men is higher in Colombia; there is more penetrating trauma and less craneocephalic trauma; patients are younger, they consult earlier, are admitted to the intensive care unit with lesser frequency, and mortality is lower than in the rest of the world. The majority of patients do not exhibit hypotension, although there is prolongation of capillary filling. The majority receive transfusions as frequently as in the rest of the world; transfusion is associated with greater mortality. Incidence of thrombotic complications are similar: Discussion. Participants in the CRASH2 study are similar in Colombia and in the rest of the world; the type of trauma and mortality are different, reflecting the state of violence in Colombia. Clinical «megastudies» are possible and are also necessary in order to answer relevant medical questions.

Palavras-chave : hemorrhage; multiple trauma; wounds and injuries; complications; mortality; tranexamic acid; multicenter study.

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