SABRE

Severe burns are devastating injuries that result in high morbidity and mortality globally. Early excision and grafting of burn wounds have become the standard of care for deep burns. This improves survival, reduces septic episodes, manages wound pain better, and mitigates the hypercatabolic response. However, substantial intraoperative blood loss remains a significant challenge during acute burns surgery. Various strategies, such as limb tourniquets, vasoconstrictors, intraoperative haemodilution, and controlled hypotension, are employed to manage this blood loss. Despite these measures, perioperative blood transfusions are often necessary, correlating with higher mortality and sepsis rates among severe burn patients.

 

Tranexamic acid (TXA), a synthetic antifibrinolytic, has proven effective in reducing blood loss and transfusion needs in several surgical and trauma scenarios. TXA works by blocking plasminogen’s interaction with fibrin, thereby preventing clot breakdown. National guidelines recommend TXA use for surgeries expecting blood loss over 500ml. Nevertheless, a national audit in the UK found that one-third of eligible patients did not receive TXA, and its application in burns surgery is not yet standard practice. Concerns about TXA potentially increasing thromboembolic risks, especially given potential for the development of a pro-thrombotic coagulopathy in the acute period following a major burn, may contribute to its limited use.

 

 

The initial aim of the SABRE study is twofold. The first is to perform a national survey of Burns Consultants and Burns Anaesthetic/ICU consultants to identify factors that guide clinicians’ use of TXA in acute burns surgery. Additionally, it will be used to investigate whether senior decision makers in burn units and centres have equipoise when it comes to potentially recruiting and randomising patients to a study investigating the effectiveness and safety of tranexamic acid in burns surgery and/or a study evaluating the safety and effectiveness of viscoelastic guided TXA use in acute burns surgery. 
Secondly, is to perform a national audit of clinical practice, examining the use of tranexamic acid in acute burns surgery against the NICE QS138 that states all adults who are having surgery and are expected to have moderate blood loss (>500ml) should be offered tranexamic acid.